Affordable Care Act Consulting Team Services

“Pay or play” rules (large employers)

  • Assist in determining large employer status
  • Assist in establishing measurement periods to determine full-time employees
  • Assist in developing compliance strategies – pay, play or both
  • Assist in determining affordability of coverage – application of safe harbors

“Controlled group” analysis

  • Determination of benefits “controlled group”
  • Determination of “large employer” status for employer “pay or play” rules

Grandfathered status of health benefit options

  • Determine whether grandfathered status has been lost due to cost/coverage changes

ACA group health plan mandates

  • Review plan for compliance with mandated benefit offerings
  • Risk assessment for penalties and corrections
  • Filing of excise tax return

Required legal notices

  • Draft required notices for ACA and other federal laws
  • Review, revise and update required notices

​Open enrollment materials

  • Review, revise and update enrollment materials

Group health plan documents

  • Draft plan documents
  • Review, revise and update plan documents

Summary plan descriptions

  • Draft summary plan descriptions
  • Review, revise and update summary plan descriptions

Flexible benefit plan or cafeteria arrangement

  • Draft plan document
  • Review, revise and update plan document

Summaries of benefits and coverage

  • Review, revise and update summaries of benefits and coverage

Medical loss ratio rebates

  • Guidance on use of rebates

Wellness programs

  • Compliance review – all applicable federal laws
  • HIPAA non-discrimination related to the ACA, GINA, ADA and other laws

Collective bargaining agreements

  • Review for required mandates, including 90-day waiting period limitation
  • Review for potential “pay or play” issues

ACA fees and excise taxes

  • PCORI (Patient-Centered Outcomes Research Institute) fees
  • Reinsurance fees
  • “Pay or play” penalties
  • Self-reporting excise taxes for failure to provide mandated benefits

Same-sex marriage

  • Advice on the impact of the Windsor decision on benefit plans and plan administration

Taxation of benefits

Review payroll tax treatment of health care benefits

Domestic partners and civil unions

Non-discrimination rules

  • Self-insured plans
  • Insured plans (after issuance of regulations)
  • Cafeteria arrangements
  • Medical flexible spending accounts

Risk analysis – potential litigation

  • ERISA 510
  • Whistleblower

Benefit claims (denial of mandated benefits)

  • Contract review – plan service providers
  • Review of insurance contracts, administrative