Additional FAQs on Affordable Care Act Released

Posted by admin on May 31, 2011  |   No Comments »

The U.S. Department of Labor (DOL) has released a new set of Frequently Asked Questions (FAQs) that address various issues related to maintaining status as a grandfathered health plan, including clarification with respect to:

  • Circumstances under which employees enrolled in one grandfathered plan or benefit package that is being eliminated may be transferred to another without causing a loss of grandfather status;
  • The effect of adopting a plan amendment which would cause a loss of grandfather status in the middle of a plan year; and
  • How to determine whether an employer’s contribution rate has decreased for purposes of maintaining grandfather status, where the employer makes contributions based on a specific formula and the cost of coverage increases over time.

For more on the Affordable Care Act, including previously released questions and answers, please visit the HR360 section on Health Care Reform.

Summary of Changes to Health Care Reform-First Anniversary Edition

Posted by admin on May 26, 2011  |   No Comments »

March 2011 marked the one-year anniversary of the Affordable Care Act being signed into law–and several requirements have changed since it was first enacted. The following summary provides a look at seven key changes to the provisions affecting employers and employer-sponsored group health plans that took place over the past year. Of particular significance, in case you missed it, was the repeal of the “1099″ reporting requirement signed by the President in April.

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New IRS Guidance on Reporting Employer-Sponsored Health Coverage on Form W-2

Posted by admin on May 23, 2011  |   No Comments »

The Internal Revenue Service (IRS) has issued interim guidance requirement under the Affordable Care Act that employers report the value of the health insurance coverage they provide employees on each employee’s annual Form W-2.

Update on Changes to the Form 5500 Series: IRS Sets Filing Dates for New Form 8955-SSA

Posted by admin on May 18, 2011  |   No Comments »

One of a number of changes made to the Form 5500 Series (used by employee benefit plans to satisfy certain annual reporting obligations) to accommodate electronic filing requirements, was the removal of Schedule SSA for plan administrators to report certain information relating to plan participants with deferred vested benefits. IRS Announcement 2011-21 designates a new form to satisfy these reporting requirements and sets the due dates for filing this form for 2009 and subsequent plan years.

Extension of Enforcement Grace Period for Select Internal Claims and Appeals Rules

Posted by admin on May 11, 2011  |   No Comments »

Extension of Enforcement Grace Period for Select Internal Claims and Appeals Rules Until Plan Years Beginning On or After Jan. 1, 2012

The Affordable Care Act generally requires group health plans (except for grandfathered plans) and health insurance issuers in the group market to implement an effective internal appeals process for coverage determinations and claims, beginning with plan years starting on or after September 23, 2010. Interim final regulations released in July 2010 by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury describe the new procedures, including seven new standards required for internal claims and appeals.

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EEOC Announces Final Bipartisan Regulations for the ADA Amendments Act

Posted by admin on May 6, 2011  |   No Comments »

Regulations Implement Congressional Intent to Simplify Definition of Disability

WASHINGTON – The U.S. Equal Employment Opportunity Commission’s (EEOC) final regulations to implement the ADA Amendments Act (ADAAA) are now available on the Federal Register website. Like the law they implement, the regulations are designed to simplify the determination of who has a “disability” and make it easier for people to establish that they are protected by the Americans with Disabilities Act (ADA).

“The ADAAA is a very important civil rights law,” said EEOC Chair Jacqueline A. Berrien. “The regulations developed by the Commission to implement the ADAAA clarify the requirements of the law for all stakeholders, which is one of the Commission’s most important responsibilities.”

“Based on the hard work we did at the Commission over the past months, I am confident that these regulations will work well for both people with disabilities and employers,” said Commissioner Chai Feldblum, who joined the EEOC in April, 2010. “It was our job as an agency to carry out the intent of this landmark law and I believe we have done so successfully.” Feldblum was one of the lead negotiators on the original ADA as well as on the Amendments Act.

“Just as the ADAAA was the result of a considerable bipartisan effort by Congress, the final rule represents a concerted effort of EEOC Commissioners representing both parties to arrive at regulations that hold true to that bipartisan Congressional intent,” said Commissioner Constance S. Barker. “I was pleased to have been able to vote in favor of the final rule.”

The ADAAA went into effect on Jan. 1, 2009. In the ADAAA, Congress directed the EEOC to revise its regulations to conform to changes made by the Act, and expressly authorized the EEOC to do so. The EEOC issued a Notice of Proposed Rulemaking seeking comment on proposed implementing regulations on September 23, 2009, and received well over 600 public comments in response. The final regulations reflect the feedback the EEOC received from a broad spectrum of stakeholders.

The ADAAA overturned several Supreme Court decisions that Congress believed had interpreted the definition of “disability” too narrowly, resulting in a denial of protection for many individuals with impairments such as cancer, diabetes or epilepsy. The ADAAA states that the definition of disability should be interpreted in favor of broad coverage of individuals. The effect of these changes is to make it easier for an individual seeking protection under the ADA to establish that he or she has a disability within the meaning of the ADA.

The ADAAA and the final regulations keep the ADA’s definition of the term “disability” as a physical or mental impairment that substantially limits one or more major life activities; a record (or past history) of such an impairment; or being regarded as having a disability. But the law made significant changes in how those terms are interpreted, and the regulations implement those changes.

Based on the statutory requirements, the regulations set forth a list of principles to guide the determination of whether a person has a disability. For example, the principles provide that an impairment need not prevent or severely or significantly restrict performance of a major life activity to be considered a disability. Additionally, whether an impairment is a disability should be construed broadly, to the maximum extent allowable under the law. The principles also provide that, with one exception (ordinary eyeglasses or contact lenses), “mitigating measures,” such as medication and assistive devices like hearing aids, must not be considered when determining whether someone has a disability. Furthermore, impairments that are episodic (such as epilepsy) or in remission (such as cancer) are disabilities if they would be substantially limiting when active.

The regulations clarify that the term “major life activities” includes “major bodily functions,” such as functions of the immune system, normal cell growth, and brain, neurological, and endocrine functions. The regulations also make clear that, as under the old ADA, not every impairment will constitute a disability. The regulations include examples of impairments that should easily be concluded to be disabilities, such as HIV infection, diabetes, epilepsy, and bipolar disorder.

Following the dictates of the ADAAA, the regulations also make it easier for individuals to establish coverage under the “regarded as” part of the definition of “disability.” Establishing such coverage used to pose significant hurdles, but under the new law, the focus is on how the person was treated rather than on what an employer believes about the nature of the person’s impairment.

The Commission has released two Question-and-Answer documents about the regulations to aid the public and employers – including small business – in understanding the law and new regulations. The ADAAA regulations, accompanying Question and Answer documents and a fact sheet are available on the EEOC website at

The EEOC enforces the nation’s laws prohibiting employment discrimination. More information is available at

Our Goal? 100% Satisfaction

Posted by admin on May 6, 2011  |   No Comments »

Navigating the murky waters of Health Care (especially during these years of reform) is challenging. You deserve informed answers to timely questions. A cornerstone of Model Consulting’s vision has always been prompt, courteous and knowledgeable customer service. Which is why we are proud to have received an overall ‘Extremely Satisfied’ rating of 90% in a ‘2011 Client Service Satisfaction’ survey. Respondents agreed that Model Consulting understood their problems and were clear and easy to understand. Furthermore representatives were able to solve problems during the initial contact or followed through with post-call commitments and promises to resolve issues.

Ray Kroc (McDonalds) once said that “If you work just for money, you’ll never make it, but if you love what you’re doing and you always put the customer first, success will be yours.” Admirable sentiments that resonate with all of us here at Model Consulting. We will not rest with 90% satisfaction. Our goal? 100% Satisfaction.