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IRS Releases Drafts of 2017 Forms 1094 and 1095 | Maryland Benefit Advisors

The IRS has released drafts of the forms and instructions that employers will use for 2017 reporting under the Affordable Care Act (ACA). It is expected that when the IRS releases final versions, the material will be virtually identical to the drafts.

Applicable large employers (ALEs) will use the following:

Employers that self-fund a minimum essential coverage plan will use the following:

Background

Applicable large employers (ALEs), who generally are entities that employed 50 or more full-time and full-time-equivalent employees in the prior year, are required to report information about the health coverage they offer or do not offer to certain employees. To meet this reporting requirement, the ALE furnishes Form 1095-C to the employee or former employee and files copies, along with transmittal Form 1094-C, with the IRS.

Employers, regardless of size, that sponsor a self-funded (self-insured) health plan providing minimum essential coverage are required to report coverage information about enrollees. To meet this reporting requirement, the employer furnishes Form 1095-B to the primary enrollee and files copies, along with transmittal Form 1094-B, with the IRS. Self-funded employers who also are ALEs may use Forms 1095-C and 1094-C in lieu of Forms 1095-B and 1094-B.

Information is reported on a calendar-year basis regardless of the employer’s health plan year or fiscal year.

Changes for 2017

The 2017 forms and instructions are similar to the 2016 materials, although there are some changes for items that no longer apply or to simplify or clarify the information. Some of the changes include:

  • Removing references to transition relief options that are no longer available to ALEs.
  • Confirming the multiemployer interim relief rule remains in place for ALEs that contribute to a multiemployer plan (e.g., union trust).
  • Updating references for items that have been adjusted for inflation, such as the affordability percentage (9.69 percent for 2017).
  • Adding a note in the instructions for Form 1095-C, line 16, stating that “There is no specific code to enter on line 16 to indicate that a full-time employee offered coverage either did not enroll in the coverage or waived the coverage.”

In general, the forms and instructions are very similar to the versions used last year. Since the reporting requirements have been in place for several years now, employers and their advisors should have little trouble in working with the new materials for 2017.

Due Dates

The due date to furnish 2017 forms to individuals is January 31, 2018, while the due date to file copies with the IRS, including the appropriate transmittal form, will depend on whether the employer files electronically or by paper. Entities that provide 250 or more forms to individuals are required to file electronically with the IRS.

The due dates for 2017 reporting are:

  • January 31, 2018: Deadline to furnish 2017 Form 1095-C (or 1095-B, if applicable) to employees and individuals.
  • February 28, 2018: Deadline for paper filing of all 2017 Forms 1095-C and 1095-B, along with transmittal form 1094-C or 1094-B, with the IRS.
  • April 2, 2018: Deadline for electronic filing of all 2017 Forms 1095-C and 1095-B, along with transmittal form 1094-C or 1094-B, with the IRS. (April 2 is the first business day following the usual due date of March 31.)

Summary

Employers are encouraged to work with experienced vendors, tax advisors, and payroll administrators to review how the ACA reporting requirements apply to their situation. The required forms are important IRS documents and preparers should use the same level of care that would apply to employee W-2s.

Originally published by www.thinkhr.com

What Are Some Pros & Cons of HIPAA? | Maryland Benefit Advisors

Congress approved the Health Insurance Portability and Accountability Act (HIPAA) to guard the privacy of personal medical information, and to give individuals the right to keep their health insurance coverage for pre-existing conditions in place even if they change jobs. The law has done this, providing important safeguards for patients. But it has also increased the red tape involved in medical care.

History

Congress passed HIPAA in August 1996, and the U.S. Department of Health and Human Services finalized standards for the electronic exchange, privacy and security of health information in 2002. The rules apply to health plans, health care clearinghouses, and to any health care provider, such as a doctor, who transmits health information in electronic form.

Significance

Congress intended HIPAA to protect individually identifiable health information. Any entity, including a physician’s office, a hospital or other health care facility, or an insurer, that deals with personal health information must follow strict rules about how to handle that information to avoid disclosing it to someone not authorized to see it. For example, Health and Human Services allows physicians and insurance companies to exchange individually identifiable health information to pay a health claim, but would not allow them to release it publicly. Penalties for violating the regulations include civil fines of up to $50,000 per violation, according to Health and Human Services.

Minimum Necessary

According to Health and Human Services, the privacy rule also requires physicians, hospitals, insurers, and other health care entities to use and disclose only the minimum amount of information needed to complete the transaction or fulfill the request. As a practical matter, for example, that means a physician should not send a patient’s entire medical file to an insurer if just one page from the record will suffice to answer the insurer’s query.

Portability

In addition to protecting patients’ privacy, HIPAA also limits the ability of a new employer plan to exclude coverage for pre-existing conditions. This means a person who has health insurance coverage can change jobs — and therefore health plans — without worrying that a condition they already have, such as diabetes or asthma, would not be covered under the new health plan. This was not always the case, according to the U.S. Department of Labor. “In the past, some employers’ group health plans limited, or even denied, coverage if a new employee had such a condition before enrolling in the plan. Under HIPAA, that is not allowed,” the Department of Labor says. HIPAA also prohibits discrimination against employees and their family members based on health histories, previous claims, and genetic information, according to the Department of Labor.

Pros of HIPAA

HIPAA, for the first time, allowed patients the legal right to see, copy, and correct their personal medical information. It also prevented employers from accessing and using personal health information to make employment decisions. And, it enabled patients with pre-existing conditions to change jobs without worrying that their conditions would not be covered under a new employer’s health plan.

Cons of HIPAA

However, HIPAA’s effects have not all been positive. The regulations increased the paperwork burden for doctors considerably, according to the American Medical Association. HIPAA has spawned a mini-industry of companies and consultants who help medical professionals comply with the law’s lengthy provisions. In addition, some professionals who deal with medical paperwork have become overcautious about releasing protected information. For example, some physician’s offices now refuse to mail test results, saying patients need to pick them up in person. And some hospitals require physicians to submit written requests on their own letterhead for information on a patient’s condition, when the law allows this information to be provided by phone.

Originally published by www.livestrong.com