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