By Alden J. Bianchi

A little more than a month ago, the Obama administration announced a one-year delay in the enforcement of the Employer “pay-or-play” rules under the Affordable Care Act—a/k/a “ObamaCare.”  Now, a handful of recent news articles have reported yet another delay in the Act’s implementation that relates to the law’s limits on out-of pocket maximum payments.  These rules place an upper limit on out-of-pocket costs, including deductibles co-payments and other cost-sharing features that are commonly encountered in employer-sponsored group health plans and in virtually all health insurance policies, whether in the individual or group markets.  A typical news article (NYT, registration required) says something like the following:

WASHINGTON — In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care. The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.  . . ..”

Continue Reading Head’s Up For Employers: (New) Confusion over Affordable Care Act Delays

By Alden J. Bianchi

On July 2, the Obama administration announced a one-year delay in employer shared responsibility (a/k/a “pay-or-play”) rules under the Affordable Care Act.  The administration’s announcement also delayed for a year certain related reporting requirements.  While this move was generally welcomed by the employer community, the delay should not be read as a reason to ignore the requirement until late next year. For certain purposes associated with the collection of data, tracking will need to begin as early as January 1, 2014 (or even earlier). Employers that fail to pay attention could find themselves having to play “catch-up.” Smart employers will use the delay to better understand the law and to chart a path to compliance. The reasons why are explained in the article found here.

In a client advisory issued yesterday, we explain how the rules governing insurance marketplaces under the Affordable Care Act affect compliance with the Massachusetts free-rider surcharge.  Specifically, beginning in 2014, employees who are ineligible for employer-sponsored group health plan coverage will no longer be able to access voluntary plan coverage under the Connector’s  Commonwealth Choice portal.  Employers that provided access to voluntary plan coverage were not subject to the Commonwealth’s “free-rider” surcharge.  As a consequence, employers must take steps to ensure that alternative coverage is available or face the prospect of a penalty.

Our advisory lists as one of the options available to employers coverage under soon-to-be-announced private exchange.  That exchange—called “Mosaic—was announced today.  For a copy the announcement, please click here.

Established as part of the 2006 Massachusetts health care reform law, the Massachusetts Health Insurance Connector served as a model for the Affordable Care Act’s American Health Benefit Exchanges, also known as insurance marketplaces. Both the Connector and the marketplaces serve as point-of-sale portals that enable individuals and small businesses to compare health insurance products, and both facilitate the purchase of coverage. But there are some important differences, and while Massachusetts has taken some steps to accommodate the Affordable Care Act, state and federal laws remain on a collision course. In a recent letter to employers, the Connector addresses these disparities and offers advice. For more information please read the advisory written by Alden Bianchi and Patty Moran.

By Jillian M. Collins

A federal district court in Florida granted a preliminary injunction prohibiting five former employees of Mainline Information Systems from soliciting certain customers and using confidential information in violation of their employment agreements and prohibiting the employees’ new employer and its senior vice president for sales from assisting the employees in any disclosure of Mainline’s confidential information or any improper solicitation of Mainline’s customers.  In Mailne Information Systems, Inc. v. Tad C. Northcott, et. al. the court found that Mainline had established that it was likely to prevail on its claims and to suffer irreparable harm from further breaches by the former employees of their employment agreements with Mainline.  The record was clear, according to the court, that the employees had violated their employment agreement.

Continue Reading “Directly or Indirectly” Means Just That ….

By Patricia A. Moran

The Affordable Care Act has established a new annual fee, imposed on group health plans, which will be used to fund the Patient Centered Outcomes Research Institute.  The amount of the fee is $1 times the average number of individuals covered under the plan for the first year, then $2 times average covered individuals thereafter.  If a health plan is insured, then the fee is paid by the insurer; if the health plan is self funded, the plan sponsor is responsible for the fee.   The fee is self reported on IRS Excise Tax Form 720. 

The fee and the filing are both due on July 31 immediately following the last day of the policy or plan year and the requirement is effective for policy and plan years ending after September 30, 2103 and before October 1, 2014.  For most plans and policies, including calendar year plans and policies, the first fee is due July 31, 2013.  

By Patricia A. Moran

Effective July 1, 2013, the Massachusetts “Fair Share” Law has been repealed as part of the Commonwealth’s 2014 fiscal year budget package. The Fair Share Law, in effect since 2006, required that employers doing business in Massachusetts either provide health coverage to full time employees that satisfies certain rules, or pay a contribution to the Commonwealth equaling $295 per employee per year.

To read more, click here.

The delay in the implementation of the Affordable Care Act’s employer shared responsibility rules, while welcome by employers, has triggered a deluge of questions. What should employers do now? Is it safe to wait until next year to think about compliance? What other provisions are affected? And, what is the impact on the efforts to modify or repeal the law. These and other issues will be addressed in an upcoming live program jointly sponsored by Bloomberg/BNA and Robert Half International.  Mintz Levin’s Alden Bianchi is one of the two featured speakers.  Click here for event details, and to register.

On January 4, we wrote that the Iowa Supreme Court ruled that a dentist acted legally when he fired a female employee because he had become irresistibly attracted to her – a situation the employer’s wife, also an employee, found objectionable. Earlier today the Court, which had taken the unusual step of granting a motion for reconsideration, upheld its decision.  According to the International Business Times, the court said “such firings do not count as illegal sex discrimination because they are motivated by feelings, not gender.” 

Please note that this decision may be limited to its facts, and may not reflect the law of any jurisdiction other than Iowa.