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Monthly Archives: February 2013

  • Getting Ready for 2014: New Information on the Pay or Play Rules” (Part One)

    Posted on February 12, 2013

    Below is the link to the recent UBA Employer Webinar Series: “Getting Ready for 2014:  New Information on the Pay or Play Rules” (Part One)

    Your name and email are required for registration.

    Beginning in 2014, employers with 50 or more full-time employees (or full-time equivalent employees) will have to either offer “affordable” health coverage of at least “minimum value” to their full-time employees or pay a penalty tax.  As 2014 approaches, employers must decide 1) if they are large enough for the employer-shared responsibility (“pay or play”) penalty to affect them; and 2) if they are large enough, how best to handle this new obligation.  If you are still wondering who exactly is an “employee” under the law, how you handle vacation time, whether you need to cover dependents, how to know if you’re large enough for the penalty to be an issue for you, and if there are special transition rules, the new proposed regulations provide answers.  In this 90-minute webinar, you will be given the answers to these questions and an explanation of some of the additional details provided in this important new guidance.  In our March webinar, the rules that apply if you are a large employer will be covered.

    PRESENTERS: Kathleen R. Barrow, Partner – Jackson Lewis LLP Kathleen has designed welfare benefit plans and executive compensation arrangements and has counseled sponsors and administrators of these types of plans for fifteen years.  She has appeared on behalf of clients before the national offices of the U.S. Treasury and the Department of Labor Employee Benefit Security Administration and has assisted employers in defending plan audits.  Kathleen is a member of the Jackson Lewis Health care Reform Task Force.

    Joyce M. Napier, Partner – Jackson Lewis LLP Joyce counsels clients in a broad range of benefit matters, including general compliance, administration of qualified retirement plans under ERISA and the Internal Revenue Code, and welfare plan issues involving cafeteria plans, health plans, flexible spending accounts, groups insurance products, COBRA and HIPAA.  She is a member of the Jackson Lewis Health Care Reform Task Force.

    * * * * * * * * * * * * *

    Please feel free to watch/listen to this whenever it is convenient for you and your staff. It will be available for you to view for the next 11 months. Your name and email are required for registration. There is no cost however, this webinar has been approved for one credit hour toward PHR, SPHR and GPHR recertification through the HR Certification Institute. Once you have viewed the webinar, the last page will provide details on receiving the credit hour.

    These webinars are designed to help keep you up to date on pertinent employee issues. We hope that you find this information valuable.

    If you would like to be removed from our distribution list or if there is someone else in your organization that you would like to receive this, please contact Karen Soule


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  • PPACA- Exchange Eligibility

    Posted on February 11, 2013

    The question most of us have had is how will employers with a non-calendar year plan be notified if their employees participate in the exchange?

    On January 14th, 2013 the DHHS issued another lengthy proposed rule under the PPACA addressing information on how an employer will be notified if an employee applies for a premium subsidy/tax credit and how an employer may appeal a determination of premiuim subsidy eligiblity that it believes is incorrect.

    As a reminder, an employee will be eligible for a premium subsidy only if:

    • Household income is less than 400 percent of federal poverty level,
    • He purchases coverage through the public exchange
    • He does not have access to affordable, minimum value coverage through his employer, and
    • He is not coverage by a plan through his employer that provides minimum essential coverage (even if that coverage is not affordable or does not provide minimum value)

    The employee will be required to provide information about his income and access to employer-provided affordable, minimum value coverage to the exchange.  The exchange or HHS if state asks HHS to do this, will attempt to verify this information from available data bases, but more than likely will need to contact the employer to verify employee’s information regarding coverage.  HHS at this time is considering the use of a one-page template that the employer would complete with all of the necessary information on that particular employee.

    Under this new proposed rule, HHS or the exchange would notify the employer if an employee is determined to be eligible for a premium subsidy.  The employer would then have 90 days to appeal the determination if it believed the employee should not qualify for the subsidy.

    All employers regardless of size would receive the notice that an employee has been found eligible for a premium subsidy.  Important:  Employers who are large enough (greater than 50 full-time employees) to be responsible for paying a penalty on employees who receive a premium subsidy would receive a separate notice from the IRS actually assessing the penalty.

    On January 2nd, 2013 the IRS issued a detailed rule that, among other things, provides that non-calendar year plans may amend their Section 125 plans to allow employees to make mid-year changes because of the PPACA.

    Open enrollment for the exchanges will begin in October of this year (2013) for a January 1, 2014 effective date, and the individual coverage mandate also begins January 1st, 2014.

    The proposed rules provide that employers with non-calendar year plans may amend their Section 125 plans to allow participants to drop coverage as of January 1, 2014 to enroll in an exchange plan.  Employers may also amend their plans to allow employees who had declined coverage to enroll and pay premiums on a pre-tax basis as of January 1, 2014, so that the employee can meet the coverage requirement.

    **Important Note- Employers considering allowing a special enrollment for those who had declined coverage should obtain consent from their carrier or reinsurer before implementing this option. Please remember HHS rules are in “proposed” stage only, which means employers should understand that changes are entirely possible.

    At Acadia Benefits we are working with our customers now to help prepare them for the changes to come with regards to the Health Care Reform.  We are partnering with our customers to develop a sound strategy to remain compliant going forward.  For more information on the Health Care Reform, and how it may affect your business, please contact Kate at Acadia Benefits at 761-2426 ext. 234 or

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