Healthcare Reform 3rd Qtr 2015 Review


Health Care Reform – Key News Items and Updates

This summary provides of an overview of key provisions under federal law issued during the third quarter of 2015. The information is subject to change based on new government requirements and/or amendments to the law. Certain requirements under the Health Care Reform apply on a plan year basis, meaning that the changes will take effect when a group health plan begins a new plan year.


September 24, 2015: CMS FAQs on Federal Marketplace’s 2016 Employer Notice Program

The Centers for Medicare and Medicaid Services (CMS) has released a set of FAQs regarding implementation of the employer notice program, which requires each federally-facilitated Health Insurance Marketplace (FFM) to notify any employer whose employee was determined eligible for advance premium tax credits (APTCs) and cost-sharing reductions, because the employee attested that he or she was neither enrolled in employer-sponsored coverage nor eligible for employer coverage that was affordable and provided minimum value.


September 21, 2015: New IRS Notice on Information Reporting by Self-Insured Employers and Other Health Coverage Providers

Newly released IRS Notice 2015-68 advises taxpayers that the Treasury Department and the IRS intend to propose regulations on minimum essential coverage (MEC) reporting by insurers and certain self-insuring employers under Internal Revenue Code section 6055.


September 18, 2015: IRS Releases Final 2015 Forms and Instructions for Employers to Report Health Coverage and ACA Compliance.

The Internal Revenue Service (IRS) has released finalized forms and instructions for 2015 to help employers prepare for compliance with the new information reporting provisions under the Affordable Care Act (ACA). Employers are required to report for the first time in early 2016 for calendar year 2015.

The following forms and instructions are now available for 2015:

Form 1094-C (transmittal)

Form 1095-C

2015 Instructions

Form 1094-B (transmittal)

Form 1095-B

2015 Instruction


September 14, 2015: IRS provides New ACA Information Center for Applicable Large Employers

Two provisions of the Affordable Care Act that apply only to companies that are considered “applicable large employers” (ALEs) under the law are now in effect: the employer shared responsibility (“pay or play”) provisions and the large employer information reporting provisions.


September 11, 2015: IRS Health Care Tax Tip: Information “Health Coverage Providers” Must Report to the IRS

Under Health Care Reform, information that self-insured employers (regardless of size) and other providers of minimum essential health coverage (MEC) will report to the IRS generally includes the following:

  • The name, address, and employer identification number (EIN) of the provider;
  • The covered individual’s name, address, and taxpayer identification number (or date of birth if a TIN is not available after providers have made reasonable efforts to obtain it); and
  • The name and TIN (or date of birth if a TIN is not available) of each individual covered under the policy or program and the months for which the individual was enrolled in coverage and entitled to receive benefits.

For information about when and how self-insured employers and other providers of MEC will report, you may review the IRS Questions and Answers on Information Reporting by Health Coverage Providers. A fact sheet is also available.


September 9, 2015: Reminder: SBCs Must Be Provided Upon Renewal of Plan Coverage

Previously released U.S. Department of Labor FAQs address the summary of benefits and coverage (SBC) notice requirements under Health Care Reform.


August 27, 2015: IRS Reminds Individuals to Determine Whether They Are Subject to the Individual Mandate

As a reminder, the individual shared responsibility (“individual mandate”) provision under Health Care Reform requires every individual to have minimum essential health coverage for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return.


August 19, 2015: What Employers Need to Know About the ACA

The IRS is reminding employers that the size and structure of their workforce will help determine which parts of the Affordable Care Act (ACA) may apply to them. Calculating the number of employees is especially important for employers that have close to 50 employees or whose workforce fluctuates during the year. For more information on these and other ACA tax provisions, visit


July 31, 2015: Additional Guidance Regarding ‘Cadillac Tax’ on High-Cost Employer-Sponsored Health Coverage

The IRS recently issued Notice 2015-52, which is intended to supplement prior guidance and continue the process of developing such guidance about the excise tax on high-cost employer-sponsored health coverage (commonly referred to as the “cadillac tax” and governed by Internal Revenue Code section 4980I).


July 24, 2015: Reminder Self-Insured Employers Must File ACA Information Returns

Regardless of size, all employers that provide self-insured minimum essential health coverage to their employees must file an annual return reporting certain information to the IRS (in addition to furnishing certain information to each employee they cover), in accordance with the information reporting requirements of the Affordable Care Act (ACA).


July 21, 2015: Pay or Play Understanding Affordable and Minimum Value Coverage

In general, under the employer shared responsibility (“pay or play”) provisions of the Affordable Care Act, a large employer may either offer affordable minimum essential coverage that provides minimum value to its full-time employees and their dependents, or potentially owe a penalty to the IRS.


July 15, 2015: New Online Tools May Help Individuals and Employers Estimate ACA Credits & Payments

The Taxpayer Advocate Service (an independent organization within the IRS) has developed several tools for individuals and small employers to assist in estimating amounts related to an employer’s small business health care tax credit, as well as an individual’s premium tax credit and individual shared responsibility (“individual mandate”) penalty under the Affordable Care Act (ACA).


July 2, 2015: New Interim Guidance on the Expatriate Health Coverage Clarification Act

IRS Notice 2015-43 provides interim guidance on the application of certain provisions of the Affordable Care Act (ACA) to expatriate health plans, based in part on the definition of an “expatriate health plan” set forth in prior agency guidance. The interim guidance is effective for policies that are issued or renewed on or after July 1, 2015 and for plan years that start on or after July 1, 2015.