President Trump Signs an Executive Order to Improve Price and Quality Transparency in Healthcare

Category: Health Care Reform

President Trump Signs an Executive Order to Improve Price and Quality Transparency in Healthcare

Posted On: July 17, 2019 | Categorized as: Health Care Reform

President Trump signed an executive order directing federal agencies to increase healthcare price and quality transparency. The order specifically directs the Departments of Labor, Treasury and Health and Human Services to issue guidance and propose regulations that would disclose negotiated rates, cost-of-care and de-identified federal healthcare data, and to expand the availability of Health Savings Accounts. The order does not immediately trigger any new federal policies, except for the specific instructions to the federal agencies to develop regulatory guidance. The order includes five main provisions instructing federal agencies to issue guidance that would:   Require hospitals to disclose information about their negotiated rates in a format that's understandable and usable by patients. Require insurance companies to provide patients with information about cost of care, including out-of-pocket costs, before they receive services. Develop a comprehensive roadmap for consistent, limited, consumer-centric quality metrics. Disclose de-identified federal healthcare data that protects patient and…

HHS Proposes to Revise ACA Section 1557 Rule

Posted On: July 17, 2019 | Categorized as: Employee Benefits, Health Care Reform

On May 24, 2019, the Department of Health and Human Services’ Office for Civil Rights (OCR) released a proposed rule to revise its regulations under the Patient Protection and Affordable Care Act’s Section 1557. OCR also released a fact sheet and press release. The proposed rule would eliminate: Certain definitions, including the definition of “covered entity” Specific nondiscrimination definitions based on sex and gender identity Translated taglines in significant consumer communications, the requirement to post information about Section 1557 and nondiscrimination at a covered entity’s locations and website, use of language access plans, and certain video standards for individuals with limited English proficiency (LEP) Any reference to a private right of action to sue covered entities for violations of the proposed rule The requirement to have a compliance coordinator and written grievance procedure to handle complaints about Section 1557 violations Enforcement-related provisions Public comment on this proposed rule will close…

Innovative Attends NAHU Capitol Conference

Posted On: February 27, 2019 | Categorized as: Employee Benefits, Health Care Reform

February 24-27th, Vice President Consulting Ryan Kastner, Director of Marketing Jamie Bratton and Vice President of HR & General Counsel, Deirdre Groenen, Esq. attended the 2019 NAHU Capitol Conference in Washington, DC. During their time in Washington, the trio attended three days of informative sessions that detailed changing legislation that directly impacts the health insurance market and engaged in discussions with lawmakers; lobbying with Senator Bob Menendez and Senator Cory Booker to affect positive change in legislation to benefit employers. Some of the speakers included health policy expert John O’Brien on President Trump’s plan to lower prescription drug prices, Special Assistant to the President for Economic Policy, Brian Blase, on Healthcare Economics, and an informative session on “Innovative Strategies to Lower Healthcare Costs” from Katy Spangler. The team is excited to share what they learned, including changes to prescription drug rebates that may be coming soon, during our upcoming “Update from…

Tax Credit Check from Horizon

Posted On: December 21, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

Attention Horizon customers! You may have received or will receive shortly, a check in the mail from Horizon regarding a tax credit refund check. Note, this is a legitimate check and you can use these funds however you see fit. Why are you receiving this check? In late 2017, the Federal Tax Reform was enacted and as a result, Horizon received a one-time tax refund in the amount of $550 million dollars from tax credits they earned over 30 years of paying federal taxes. Consistent with Horizon’s mission to serve their members, Horizon BCBSNJ is using $275 million of its tax refund for their members. On December 17, 2018, Horizon BCBSNJ issued a one-time distribution to commercial Individual market members, small group customers, and fully insured and self-insured group customers with 51 or more employees: Individual market subscribers with a Single contract received a distribution of $500. Individual market subscribers…

November Compliance Recap

Posted On: December 10, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

November was a busy month in the employee benefits world. The Internal Revenue Service (IRS) extended the due date for employers to furnish Forms 1095-C or 1095-B to individuals, extended "good faith compliance efforts" relief for 2018, and issued specifications for employer-provided substitute ACA forms. The Department of the Treasury (Treasury), Department of Labor (DOL), and Department of Health and Human Services (HHS) released two final rules on contraceptive coverage exemptions. The IRS released indexed Patient-Centered Outcomes Research Institute (PCORI) fees and inflation-adjusted limits for various benefits. The DOL, IRS, and the Pension Benefit Guaranty Corporation (PBGC) released advance informational copies of the 2018 Form 5500 annual return/report and instructions. For survivors of the 2018 California wildfires, the IRS provided tax relief and the DOL released employee benefit guidance. The IRS provided guidance to employers who adopt leave-based donation programs to provide charitable relief for victims of Hurricane Michael. The…

Innovative Compliance- The New Jersey Equal Pay Act

Posted On: November 13, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

As of July 1, 2018, the Diane B. Allen Equal Pay Act (“the Act”), which amends the New Jersey Law Against Discrimination (“LAD”), went into effect in New Jersey. The Act applies to all New Jersey public and private employers regardless of size, except federal employers. Pursuant to the Act, it is unlawful for an employer to pay a member of a protected class at a rate of compensation, including pay and/or benefits, lesser than that paid to employees who are not members of the protected class for “substantially similar” work unless justified by a legitimate business necessity.  The protected classes under the LAD include race, creed, color, national origin, nationality, ancestry, age, sex, pregnancy, familial status, marital status, domestic partnership or civil union status, affectional or sexual orientation, gender identity or expression, atypical hereditary cellular or blood trait, genetic information, liability for military service, and mental or physical…

Important NJ Earned Sick Leave Update

Posted On: November 1, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

In yesterday's blog post, we discussed the New Jersey Earned Sick Leave Law, which went into effect this Monday, October 29th.  For more on the specifics of the law, click here.  In addition to the employer obligations outlined in the previous post, all employers with employees working in New Jersey must post the New Jersey Department of Labor’s notice, in a conspicuous place at each of your work locations and provide employees with a written copy of the notification within 30 days of its issuance, by November 29th, 2018. Here is a poster that has the information from the NJ DOL. The wording can be edited and copied to use as an official, written notification to all of your NJ employees. If you have any questions regarding this law and your obligations as an employer, please contact us here.

NJ Earned Sick Leave Law Goes into Effect

Posted On: October 31, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

For New Jersey employers (or PA, NY or other employers who have employees who work in NJ), the NJ Earned Sick Leave Law went into effect Monday, October 29, 2018. Below is a link to a very comprehensive list of FAQs on the law, but here are some highlights: There is no minimum number of employees that an employer must have to fall under the law. Full-time, part-time, and seasonal employees accrue 40 hours of sick leave in a benefit year. The benefit year can be calendar-year or some other set 12-month period, but it must be the same for all employees. Accrual of sick leave is 1 hour for every 30 hours worked, and the 30 hours can be worked over multiple workweeks (ex. a part-time employee who works 15 hours a week accrues 1 hour of sick leave after 2 weeks of work). Employers must allow carryover of…

June Compliance Recap

Posted On: July 11, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

June was a relatively quiet month in the employee benefits world. The U.S. Department of Labor issued final regulations regarding association health plans. The U.S. Department of Justice filed a response in ongoing litigation regarding the constitutionality of the Patient Protection and Affordable Care Act. The Centers for Medicare and Medicaid Services released a form that certain plan sponsors will use for reporting limited wraparound coverage. DOL Issues Final Regulations Regarding Association Health Plans On June 19, 2018, the U.S. Department of Labor (DOL) published Frequently Asked Questions About Association Health Plans (AHPs) and issued a final rule that broadens the definition of "employer" and the provisions under which an employer group or association may be treated as an "employer" sponsor of a single multiple-employer employee welfare benefit plan and group health plan under Title I of the Employee Retirement Income Security Act (ERISA). The final rule is intended to facilitate adoption and administration…

Compliance Alert! – NJ Gov. Phil Murphy Signs Two New Healthcare Acts into Law

Posted On: June 4, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

This past week, New Jersey Governor, Phil Murphy, signed two bills into law that will impact New Jersey residents. Employers who offer benefits in New Jersey and surrounding states should be mindful of these changes as they will affect employees who reside and/or receive medical treatment in New Jersey. Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act Last Thursday, Governor Phil Murphy signed Assembly Bill No. 2039, which protects healthcare consumers from unexpected bills from out-of-network health services. This bill requires healthcare facilities to increase disclosure and transparency for non-emergency patients. Providers will be required to disclose their out-of-network status to patients before rendering services and provide a disclaimer that the patient will be responsible for any out-of-network fees along with an estimate of those fees (upon request). Providers will also be required to publicly post their standard charges. Insurance carriers will be responsible for maintaining a telephone hotline…

2018 Health Savings Account Contribution Limits Change Once Again

Posted On: April 27, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

If you recall, after the passing of the tax reform bill, known formally as the Tax Cuts and Jobs Act, the IRS adjusted the amount for HSA family contributions from $6,900 to $6,850 due to a change in inflation calculations. After public outcry and consideration of the administrative and financial burdens this change would have on tax payers, the IRS has released a notice allowing for taxpayers to treat $6,900 as the annual limitation for an individual in family coverage under a high deductible health plan (HDHP) for 2018. The IRS allows for individuals who have reduced their HSA contribution to meet the $6,850 change, via a distribution from the account, to repay the additional $50 without requiring an additional reporting to the IRS. Therefore, individuals who wish to maximize their HSA contribution limit, for 2018, may utilize the $6,900 limit, if enrolled in family coverage under a qualified HDHP,…

New Jersey Newborn Mandate Changes in 2018

Posted On: April 17, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

In January 2018, the State of New Jersey updated the existing NJ Newborn Mandate that provides health coverage for all newborns from the moment of birth for the first 31 days to provide coverage from the moment of birth for the first 60 days. The newborn child of a subscriber or his/her spouse will be covered for necessary care, injury and sickness. Please note, this mandate does not apply to newborns of dependent children. For coverage beyond the 60 days, most plans require the subscriber to notify the health plan or Human Resources of the birth and the addition of the newborn to the policy. The subscriber may incur additional premium costs for this addition. For all fully insured groups, the mandate will be applied on renewal on or after January 16, 2018. For self-funded health plans on renewal on or after January 16, 2018, these plans are not subject…

March Compliance Recap

Posted On: April 5, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

March was a quiet month in the employee benefits world. The Internal Revenue Service (IRS) released a bulletin that lowered the family contribution limit for health savings account (HSA) contributions. The U.S. Department of Labor (DOL) updated its model Premium Assistance Under Medicaid and the Children's Health Insurance Program notice (CHIP notice). The IRS issued its updated Employer's Tax Guide to Fringe Benefits, issued transition relief regarding HSA eligibility of individuals with health insurance that provides benefits for male sterilization or male contraceptives without a deductible, and issued its updated Guide on Health Savings Accounts and Other Tax-Favored Health Plans.   IRS Releases Adjusted Annual Inflation Factor The Internal Revenue Service (IRS) released its Internal Revenue Bulletin No. 2018-10 that adjusted the annual inflation factor from the Consumer Price Index (CPI) to a new factor called a chained CPI. This is retroactively effective to January 1, 2018. As a result of the…


Posted On: March 6, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

Yesterday, the Internal Revenue Service (IRS) released a bulletin that includes a change impacting contributions to Health Savings Accounts (HSAs) and Employer Adoption Assistance Programs. The family HSA contribution for 2018 has been reduced from $6,900 to 6,850. This change is effective January 1, 2018. We advise plan participants to adjust their HSA contributions, if utilizing the maximum contribution for the 2018 calendar year. The individual, self-only, maximum HSA contribution limit has not changed. The current 2018 HSA contribution limits are $3,450 for self-only coverage and $6,850 for family coverage. For employer adoption assistance programs, the maximum amount that can be excluded from an employee’s gross income for qualified adoption expenses is reduced from $13,840 to $13,810. Further, the adjusted gross income threshold after which adoption exclusion begins to phase out is reduced from $207,580 to $207,140. The reason for the change, is due to adjustments made to accommodate the new tax law, Tax Cuts and Jobs Bill, at the end…

Trump Signs Bill to Delay Cadillac and Health Insurance Taxes

Posted On: January 23, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

On January 22, 2018, the U.S. Congress voted to pass a bill that would continue to fund the government through February 8, 2018. President Trump signed the bill today, January 23, 2018. In addition to continuing government funding, the bill also includes two legislative victories for employers: delaying the Cadillac Tax until 2022 and instituting a moratorium of the Health Insurance Tax (HIT), effective for 2019. If you recall, the Cadillac Tax refers to a provision in the ACA imposing an annual 40% excise tax on plans with annual premiums exceeding 10,800 for individuals or $29,500 for a family starting in 2020. This bill, effectively delays the Cadillac Tax for an additional two years. The Health Insurance Tax (HIT) included in the ACA increase the cost of healthcare coverage for consumers and employers in each state and is intended to impose a sales tax on health insurance to increase tax…

December Compliance Recap

Posted On: January 9, 2018 | Categorized as: Company News, Employee Benefits, Health Care Reform

December was a relatively busy month in the employee benefits world. The Internal Revenue Service (IRS) delayed the reporting deadlines in 2018 for the 1095-B and 1095-C forms to individuals. President Trump signed the Tax Cuts and Jobs Act. The Centers for Medicare and Medicaid Services (CMS) released guidance on accommodation revocation notices. A U.S. District Court vacated U.S. Equal Employment Opportunity Commission (EEOC) wellness rules effective January 1, 2019. The U.S Department of Health and Human Services' Office of Child Support Enforcement (OCSE) issued Frequently Asked Questions to address employers' duties regarding medical support notices. The IRS released Form 8941 instructions regarding credit for small employer health insurance premiums and Form W-2 reporting guidance for Qualified Small Employer Health Reimbursement Arrangements (QSEHRAs). IRS Extends 2018 Deadlines for 1095-B and 1095-C Forms to Individuals On December 22, 2017, the Internal Revenue Service (IRS) issued Notice 2018-06, delaying the reporting deadlines…

IRS Announces Extension for Furnishing 1095-B & 1095-C Forms to Employees

Posted On: December 27, 2017 | Categorized as: Company News, Employee Benefits, Health Care Reform

Recently, the Internal Revenue Service announced an extension for employers to provide 1095-B or 1095-C Forms to their employees. The IRS announced a 30-day extension, extending the due date from January 31, 2018 to March 2, 2018. The IRS has not announced an extension for filings to the IRS. Therefore, employers should prepare their 1094-B, 1095B, 1094-C, and 1095-C filings for submission to the IRS by February 28, 2018, if filing by paper or April 2,2018 if filing electronically.  This extension was made in response to requests by employers, insurers, brokers, and other providers of health insurance coverage that additional time be provided to gather and analyze the information required to complete the 1095 forms. The IRS also announced that good faith standards will once again apply for the 2017 forms. This means that employers will not be subject to reporting penalties for incomplete or incorrect information, provided they can…

IRS to Send ACA Penalty Letters

Posted On: November 30, 2017 | Categorized as: Company News, Employee Benefits, Health Care Reform

The Internal Revenue Service (IRS) has indicated that it plans to begin notifying employers by year end of their potential liability for failing to provide sufficient health coverage that is compliant with the Patient Protection and Affordable Care Act (ACA). The agency will begin notifying Applicable Large Employers (ALEs) of their potential liability for the Employer Shared Responsibility Payment (ESRP) if any, for the 2015 calendar year. An ALE would be subject to a penalty, if, for at least one month in the year, one or more of its full-time workers received a premium tax credit through the ACA’s Health Insurance Marketplace, because the ALE did not provide compliant health coverage. The affected employers should expect to receive a Letter 226-J, a Preliminary Calculation of the Employer Shared Responsibility Payment. This Letter 226-J will be used to notify employers that they may be liable for an ESRP. The determination of…

DOL Overtime Rule Defeated in Court, DOL to Appeal

Posted On: November 8, 2017 | Categorized as: Company News, Employee Benefits, Health Care Reform

As you may recall, the Department of Labor put forth overtime regulations that would have taken effect last December, enabling 4.2 million employees to be eligible for time and a half wages for every hour worked over the standard 40 hours per week. However, a number of business groups filed a lawsuit challenging the DOL’s rule in court, and 21 state attorneys general worked together to file a separate action, challenging the rule. The U.S. District Court for the Eastern District of Texas combined both cases and U.S. District Judge Amos Mazzant ruled recently that the salary threshold that establishes which employees are eligible or exempt from overtime was unreasonably high. Previously, Judge Mazzant imposed a preliminary injunction on the rule, blocking the rule from implementation on December 1, 2016. However, in his most recent ruling, Judge Mazzant formally overturned the DOL overtime regulation. The DOL last week sought to…

President Trump Ends ACA Cost Sharing Reductions

Posted On: October 12, 2017 | Categorized as: Company News, Employee Benefits, Health Care Reform

On the evening of October 12, 2017, President Trump announced that cost sharing reductions for low income Americans in relation to the Patient Protection and Affordable Care Act (ACA) would be stopped. The Department of Health and Human Services (HHS) has confirmed that payments will be stopped immediately. It is anticipated at least some state attorneys general will file lawsuits to block the ending of the subsidy payments, with California Attorney General Xavier Becerra stating he is prepared to file a lawsuit to protect the subsidies. Background Individuals with household modified adjusted gross incomes (AGIs) in excess of 100 percent but not exceeding 400 percent of the federal poverty level (FPL) may be eligible for cost-sharing reductions for coverage purchased through health insurance exchanges if they meet a variety of criteria. Cost-sharing reductions are limited to coverage months for which the individual is allowed a premium tax credit. Eligibility for…

Need a custom plan designed for your team?

Schedule a Consultation

Contact Us Now To Get Your Business Covered