Viewing posts from: June 2015

Same-Sex Marriage Is a Right, Supreme Court Rules, 5-4

Posted June 26, 2015 by PHaynes

USSC_06-26-2015_Same_Sex_MarriageToday, the Supreme Court rules that the Constitution guarantees a nationwide right to same-sex marriage.

Justice Anthony M. Kennedy wrote the majority opinion in the 5 to 4 decision. He was joined by the court’s four more liberal justices. With this decision the Supreme Court is affirming that the Constitution requires that same-sex couples be allowed to marry no matter where they live and that states may no longer reserve the right only for heterosexual couples.

The decision, the culmination of decades of litigation and activism, came against the backdrop of fast-moving changes in public opinion, with polls indicating that most Americans now approve of same-sex marriage.

As in earlier civil rights cases, the Supreme Court had moved cautiously and methodically, laying careful judicial groundwork for a transformative decision.

As late as October, the justices ducked the issue, refusing to hear appeals from rulings allowing same-sex marriage in five states. That decision delivered a tacit victory for gay rights, immediately expanding the number of states with same-sex marriage to 24, along with the District of Columbia, up from 19.

Largely as a consequence of the Supreme Court’s decision not to act, the number of states allowing same-sex marriage has since grown to 36, and more than 70 percent of Americans live in places where gay couples can marry.

The court did not agree to resolve the issue for the rest of the nation until this past January (2015) in cases filed by gay and lesbian couples in Kentucky, Michigan, Ohio and Tennessee. The court heard extended arguments in April (2015), and the justices seemed sharply divided over what the Constitution has to say about same-sex marriage.

Lawyers for the plaintiffs said their clients had a fundamental right to marry and to equal protection, adding that the bans they challenged demeaned their dignity, imposed countless practical difficulties and inflicted particular harm on their children.

The Obama administration, which had gradually come to embrace the cause of same-sex marriage, was unequivocal in urging the justices to rule for the plaintiffs. “Gay and lesbian people are equal,” Solicitor General Donald B. Verrilli Jr. said. “They deserve equal protection of the laws, and they deserve it now.”

Lawyers for the four states said their bans were justified by tradition and the distinctive characteristics of opposite-sex unions. They added that the question should be resolved democratically, at the polls and in state legislatures, rather than by judges.

“Under the Constitution, same-sex couples seek in marriage the same legal treatment as opposite-sex couples, and it would disparage their choices and diminish their personhood to deny them this right,” Justice Anthony Kennedy wrote in the majority opinion. He was joined in the ruling by the court’s liberal justices Ruth Bader Ginsburg, Stephen G. Breyer, Sonia Sotomayor and Elena Kagan.

All four of the court’s most conservative members — Chief Justice John G. Roberts Jr. and Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. — dissented and each wrote a separate opinion, saying the court had usurped a power that belongs to the people.

Reading a dissent from the bench for the first time in his tenure, Roberts said, “Just who do we think we are? I have no choice but to dissent.”

In his opinion, Roberts wrote: “Many people will rejoice at this decision, and I begrudge none their celebration. But for those who believe in a government of laws, not of men, the majority’s approach is deeply disheartening.”

Scalia called the decision a “threat to American democracy,” saying it was “constitutional revision by an unelected committee of nine.”

In a statement in the White House Rose Garden, President Obama hailed the decision: “This ruling is a victory for America. This decision affirms what millions of Americans already believe in their hearts. When all Americans are truly treated as equal, we are all more free.”

With this decision the Supreme Court is affirming that the Constitution requires that same-sex couples be allowed to marry no matter where they live and that states may no longer reserve the right only for heterosexual couples.

Links and additional news/details:

US Supreme Court Upholds Subsidies

Posted June 25, 2015 by PHaynes


The Affordable Care Act survived its second Supreme Court test in three years. In a 6-3 majority ruling, the Supreme Court upheld the federal government’s authority to provide health insurance subsidies through a federal exchange.

The King v. Burwell decision ultimately hinged on just four words — “established by the State.” The decision reviewed in detail if this phrase, in the context of the overall “statutory scheme,” meant simply that subsidies were only available to individuals who enrolled in an insurance plan on an exchange actually established by a state; or, if it could mean that these subsidies were available to individuals who enrolled in an insurance plan on either a state or a federal exchange. After looking at the language in the context of the entire statute, the court decided on the latter interpretation. The 6-3 ruling stopped a challenge that would have erased subsidies in at least 34 states for individuals and families buying insurance through the federal government’s online marketplace.

Chief Justice John Roberts wrote the opinion for the court, joined by Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonya Sotomayor and Elena Kagan. Opposing the decision were Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr.

Kennedy’s position in the majority was particularly significant. He had earlier been among the four justices who would have found the entire law unconstitutional

Scalia said Roberts, who also wrote the decision in 2012 that saved the Affordable Care Act from that challenge, has performed “somersaults of statutory interpretation” to preserve the act: “We should start calling this law SCOTUScare.”

Though there was much discussion in the opinion about the “inartful drafting” of the ACA, ultimately, the majority did not allow this persuade them to hand down a ruling that could potentially dismantle the ACA. Indeed, Roberts’ wrote, “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them….The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner.” Based on this ruling, at this juncture, everything regarding the ACA remains status quo.

Source: Kaiser Health News, The Council of Insurance Agents and Brokers, Washington Post

AP Benefit Advisors, LLC Acquires Pennsylvania-based StoudtAdvisors

Posted June 22, 2015 by Megan DiMartino

logoAP Benefit Advisors, one of the nation’s largest and best-equipped full-service benefits consulting and brokerage firms, announces today the acquisition of announces today the acquisition of StoudtAdvisors. The independent insurance broker specializes in employee benefits programs and human resources consulting services to businesses of all sizes in Central Pennsylvania and beyond. Its 14 employees will join AP Benefit Advisors and will continue to operate from its existing Lancaster, Pa.-based office, under the local leadership of CEO and President David Stoudt.

As a second generation family-owned business since 1989, StoudtAdvisors helps clients develop and implement an innovative benefits package to maximize the health of their employees and business.  The firm’s private health care exchange, Bright Choices, serves to support companies in managing their benefits budget. StoudtAdvisors also brings client expertise in all key human resources disciplines, including compensation, compliance, training and development, HR strategic planning and more.

“We operate under the same philosophy as when my father founded the company—clients deserve a far more in-depth approach with personalized, one-on-one benefit solutions,” said Stoudt.  “As part of AssuredPartners and in, we will remain committed to partnering with our clients in a meaningful, personal way.”

“As we continue our expansion efforts with AssuredPartners, we look for agencies that share AP Benefit Advisors’ values and commitment to excellence,” said AP Benefit Advisors President Reagan Crawford. “AP Benefit Advisors has served employee benefit needs since 1977 and has thrived on client-driven innovation. We welcome our newest associates to AP Benefit Advisors and AssuredPartners.”

For more information about StoudtAdvisors, visit:

IRS Releases Draft 2015 Forms 1094 and 1095

Posted June 19, 2015 by PHaynes

IRS-logoOn Tuesday of this week, the IRS release 2015 versions of Form 1094 and 1095. These will be used to report information that is needed to satisfy and comply with both the Individual Mandate and the Employer Shared Responsibility provisions of the Affordable Care Act (in addition to assisting with the complex evaluation process for who qualifies for premium tax credits (subsidies for coverage)).

These drafts 2015 forms are virtually identical to their 2014 version.   However, there are always a few minor edits.


  • Other than slight language-related differences, the draft 2015 “B” Forms as well as the draft 2015 Form 1094-C have not been changed.
  • The draft 2015 1095-C Form does, however, indicate one anticipated change. The IRS added one new field on the draft 2015 1095-C Form to specify the month the Applicable Large Employer’s plan year begins. This new field is titled “Plan Start Month” and appears to be optional for the 2015 filing.
  • Additionally, although not a substantive change, both Part III of the draft 2015 1095-C Form and Part IV of the draft 2015 1095-B Form includes a “continuation sheet.” This sheet is to be used for filers that are reporting enrollment information for more than six individuals.

Based on the information presented in the draft 2015 Forms, it does not appear that any significant changes will be made to the 2015 ACA reporting forms. However, until the IRS releases corresponding instructions for these forms and the final versions, we will not have all of the information to fully prepare for the 2016 filing deadlines. Until then, the IRS has made some additional information available on how employers and/or third parties should file through the IRS’s new electronic filing system. (See IRS draft Publication 5165 for more information.)

You may also like to review IRS Publication 5196 on the Employer Reporting Requirements (of the ACA).


Other Guidance:

Webinar: Affordable Care Act – Employer Reporting and Compliance Update

Posted June 17, 2015 by Megan DiMartino

Join AP Benefit Advisors General Counsel and Vice President-Compliance, Patrick Haynes, for this complimentary webinar, as he reviews reporting and compliance pertaining to IRS Sections 6055 and 6056. Noncompliance penalties relating to violations are significant, and can result in fines up to $1.5 million. Many employers are struggling to understand all reporting requirements, what to file and when the forms should be filed. It’s a long and complex list, and it is not surprising so many human resource departments are finding this an overwhelming task. Employers seeking to better understand the nuances of these requirements, should attend this complimentary webinar. Topics include:

• Exchange Form 1095-A with IRS
• Minimum Essential Coverage (MEC)
• Form 8962 – Premium Tax Credit
• Reporting Under Section 6055/6056
• Section 4980H – Shared Responsibility for Employers
• Penalties for Noncompliance
• Forms 1094-B/C & 1095-B/C
• Section 4980H
• Examples, Explanations and Simplification

Open to all HR professionals – but not brokers, agents, TPAs, PEOs

Date & Time: Thu, Jun 25, 2015 12:00 PM – 12:35 PM EDT
Space is limited – click here to register:

Webinar: ACA and Medicaid Migration Benefits – Helping Employees Increase Coverage While Reducing Employer Costs

Posted June 17, 2015 by admin

ACAJoin us for this concise, and informative webinar about Medicaid Migration Benefits and how larger employers can help employees increase coverages, reduce employer health plan costs and ensure ACA compliance. Employers that migrate low-wage workers to Medicaid can significantly reduce healthcare expenses while still meeting the ACA Employer Mandate. This solution provides low-wage employees and their families, who might not have been able to afford health insurance, access to free comprehensive healthcare. The results include a healthier, more productive workforce, and an improved bottom line. By migrating low-wage employees to Medicaid for coverage, employers can significantly cut their healthcare expenses and improve the bottom line while putting their employees’ well being first. Learn more about Medicaid Migration Benefits, in this complimentary webinar. Topics include:

• Qualification criteria for Medicaid Migration
• Helping low low-wage employees sign up
• Educating employees about their healthcare options
• Determining if employees are eligible for other benefits (food stamps, a free phone, etc.)

Open to all HR professionals – but not brokers, agents, TPAs, PEOs

Date & Time: Wed, Jun 24, 2015 1:00 PM – 1:35 PM EDT
Space is limited – click here to register:

AP Benefit Advisors Acquires Benefits Agency WorkforceTactix, Inc.

Posted June 11, 2015 by Megan DiMartino


WorkFAP Benefit Advisors, one of the nation’s largest and best-equipped full-service benefits consulting and brokerage firms, announces today the acquisition of WorkforceTactix, Inc., a Maryland based employee benefits and HR professional services consulting firm. The firm’s 36 associates will join AP Benefit Advisors, an AssuredPartners subsidiary in Hunt Valley, Maryland, but will continue to operate from their existing location in Sparks and Salisbury, Maryland.

Founded in 1981, the Workforce team provides strategic expertise in health and welfare planning, voluntary benefits, human resource compliance, professional services and more. “We’ve developed a strong brand in the mid-Atlantic marketplace as a result of our strategy and talent, and have grown our platform based on feedback from our valued clients,” said WorkforceTactix CEO Christopher Swam. “As part of AP Benefit Advisors and AssuredPartners, we look forward to building upon our success by leveraging their national platform, gaining access to a broader selection of insurance products, and utilizing their enhanced client resources.”

“As we continue our expansion efforts with AssuredPartners, we look for agencies that share AP Benefit Advisors’ values and commitment to excellence,” said AP Benefit Advisors President Reagan Crawford. “AP Benefit Advisors has served employee benefit needs since 1977 and has thrived on client-driven innovation. We welcome our newest associates to AP Benefit Advisors and AssuredPartners.”

HHS Seeks Public Comments on HIPAA Health Plan Identifiers

Posted June 10, 2015 by Megan DiMartino

US-DeptOfHHS-Seal-3D.svg (1)from EBIA

HHS has issued a request for information (RFI) seeking public comments regarding whether changes should be made to its policy on health plan identifiers (HPIDs). As background, HIPAA—enacted in 1996—required HHS to adopt standards for a unique identifier for health plans to use in standard transactions. Congress subsequently established—as part of health care reform—an October 1, 2012 deadline for HHS to adopt standards, based on input from the National Committee on Vital and Health Statistics (NCVHS). In September 2012, HHS issued regulations requiring large health plans to obtain HPIDs by November 5, 2014 (small plans were given until November 5, 2015) and mandating use of HPIDs to identify health plans in standard transactions beginning November 7, 2016.

But a few days before the November 5, 2014 deadline, HHS announced an indefinite enforcement delay. HHS’s announcement referred to a recommendation from NCVHS questioning the business need, purpose, benefit, and value of HPIDs, especially in light of widespread integration of the Payer ID, a standardized national payer identifier based on the NAIC identifier, into administrative systems used to process transactions. NCVHS concluded that modifying the Payer ID would cause significant disruption in routing and processing transactions.

Citing “sweeping changes” in the nation’s health care system since publication of the HPID regulations (including implementation of Exchanges under health care reform), the RFI requests public input regarding three specific topics:

  • The enumeration structure outlined in the HPID regulations, including the controlling health plan, subhealth plan, and other entity identifier (OEID) concepts.
  • Use of HPIDs in conjunction with Payer IDs in standard transactions.
  • Whether changes to the health care system since publication of the HPID regulations have altered commenters’ perspectives about HPIDs.

The deadline for submitting comments is July 28, 2015.

Top Benefits Regulation Updates

Posted June 4, 2015 by admin

congressNew and revised benefits and compliance regulations continue to pour forth in the aftermath of the epic legislation in recent years. The latest updates cover a broad array of laws and regulations that apply to a wide range of businesses across the United States. Failing to understand requirements, opportunities, and the state of employee benefits can cost you. Learn more:

For more on these and other significant regulatory updates, contact us.

PCORI or CERF? Whatever you call it, remember that the IRS raised the fee.

Posted June 3, 2015 by PHaynes


With the release of Internal Revenue Service Notice 2014-56, the IRS provided the adjusted applicable dollar amount for the third filing of the Patient-Centered Outcomes Research Institute fee [Research Fee, PCORI or CERF (Comparative Effectiveness Research Fee)].

The adjusted dollar amount for plan years beginning November 1, 2013 through October 1, 2014 is $2.08 (that’s an 8 cent increase).

As you will recall, for self-insured plans and HRAs, the Research Fee is due by July 31st of the calendar year following the end of the applicable plan year. It is paid on the 2nd quarter Form 720 filing. The next payment and filing deadline is July 31, 2015.


Prior guidance, updates and background reading follows.


Update! IRS Rule for PPACA’s “Comparative Effectiveness Research Fee” (CERF/PCORI/IRS Form 720)

Patrick C. Haynes, Jr., Esq., LL.M.

Update (June 4, 2013)IRS Form 720 now includes, at Part II (page 2 of 7) at line 133, a space to include your headcount, multiply it by $1 (for this year) and $2 for all subsequent years (until it sunsets with the 2019 plan year).  Your completed, signed Form 720 is due by July 31, 2013, along with your payment.

Original Article posted June 11, 2012, 7:36 a.m.

Key Dates for Self-Funded Plans to Keep in Mind

  • 07-15-2012   Comments due to the IRS
  • 08-08-2012   Public Hearing
  • 10-01-2012   $1 per life fee assessed for plan years ending on/after 10-01-2012.
  • 07-31-2013   Date upon which a 1/1 Plan must file an IRS Form 720 and pay fee  [I’m not a 1/1 Plan – when is my form due?].

The Affordable Care Act (PPACA) includes a provision imposing an annual assessment on insurers and group health plans to fund a Patient-Centered Outcomes Research Institute (PCORI), which will assist patients, clinicians, purchasers and policy-makers in making informed health decisions by advancing comparative clinical effectiveness research.

The Institute is funded by a trust fund, which, in turn, is partially funded by fees paid by issuers of health insurance policies and sponsors of self-insured health plans. This “comparative effectiveness research fee” applies to policy/plan years ending on or after 10/1/2012.

Proposed regulations were published on April 12 and, although not yet final, this Proposed Rule provides more information on calculation, reporting and payment of the fee.  Read the IRS’ proposed rules here:

The fee applies to fully insured and self-funded medical plans covering U.S. residents; expatriate plans are excluded. It also applies to individual/family plans, voluntary/mini-med plans and retiree-only plans.

Health Reimbursement Accounts (HRAs) linked to a self-insured health plan are exempt; the employer will pay one fee for the medical plan only. But if the HRA is linked to an insured health plan, the employer will pay the fee for the health plan and the carrier will pay for the insured plan – two fees will be collected.

The fee does not apply to Medicare, Health Savings Accounts (HSAs) or ERISA excepted benefits (such as non-bundled dental and vision).

Fees, Payment and Reporting
The initial annual fee is $1 per average covered life.  The fee is not assessed only upon employees, but includes a complicated series of calculations designed to capture the total number of covered lives (including spouses and dependents).  The fee increases to $2 in 2013, then to an amount indexed to national health expenditures until 2019, when it is scheduled to end.

Reporting and payment using IRS Form 720 is required by July 31 of the calendar year immediately following the last day of the policy or plan year. For example, the fee for the policy or plan year ending on December 31, 2012 must be filed by July 31, 2013. Liability for a plan year ending on June 30, 2013 must be filed by July 31, 2014.

Comment Period and Public Hearing
Comments are due on 7/15/2012 (90 days after official publication). There will also be a public hearing on August 8, 2012. Anyone wishing to present oral arguments must submit written or electronic comments, an outline of topics to be discussed and the time to be devoted to each topic by July 30, 2012.

Fee Calculation Methodologies
Employers and health plans may choose one option from the following:

  1. Actual Count Method: Add the total number of covered lives for each day of the policy year and divide by the number of days in the policy year.
  2. Snapshot Method:  Add the totals of lives covered on one date in each quarter of the policy year (or more dates if an equal number of dates is used for each quarter) and divide by number of dates on which a count was made. The date(s) for each quarter must be the same (e.g., 1st day of quarter, last day of quarter, or 1st day of each month).
  3. Member Months Method: The sum of the totals of lives covered on pre-specified days in each month of the reporting period) as reported on the National Association of Insurance Commissioners (NAIC) Supplemental Health Care Exhibit filed for that calendar year. The average number of covered lives under the policies in effect for the calendar year equals the member months divided by 12.
  4. State Form Method:  An insurer not required to file NAIC annual financial statements may calculate covered lives for the calendar year using a form filed with the insurer’s state of domicile and a method similar to the member months method, if the form reports the number of covered lives in the same manner as member months are reported on the NAIC Supplemental Health Care Exhibit.

Supreme Court Decision Looms

The U.S. Supreme Court’s decision on PPACA’s constitutionality (among the other items/issues that were debated) is due by the end of the court’s current term, June 30th.  Assuming PPACA remains the law of the land, the next step for this fee will be the close of the comment period (July 15, 2012), a public hearing August 8, 2012 and then IRS Form 720 completion and payment of the fee in July of 2013 (for 1/1 plans).  Please contact your Account Executive or Account Manager for additional information or assistance.


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