Why Generic Drugs Can Be The Better Choice

By Carol Taylor

Several years ago, I went to the doctor for a sinus infection. While waiting for the doctor to return with a prescription, I happened to look over and notice that every jar, pen, notepad, etc. on the counter had the name of a recently released brand name antibiotic. Sure enough, when the doctor returned, it was for that particular drug. I asked the doctor what the cost of the drug was, since I was covered under a high-deductible health plan (HDHP) and would be paying the full cost. When he responded that it would run about $360 for six pills, I immediately demanded a generic prescription. The generic drug was less than $15 and took care of the infection. To add insult to injury, no one knew at the time, but the brand name later was found to have some unknown side effects -- several people died, and the drug was “black-boxed” by the FDA shortly thereafter and removed from the market. I was quite glad that my frugal side had taken over when I read that in the news.

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Feds clarify same-sex married couples’ Obamacare eligibility

By Jared Bilski

Will a legally married same-sex couple be able to buy a family health insurance policy on the federal exchanges if they live in a state that doesn’t recognize same-sex marriage?  

Absolutely. Any insurers that participate in the Obamacare exchanges must offer coverage to same-sex married couples. That’s what the Department of Health and Human Services (HHS) announced recently.

Coverage canceled, enrollment denied

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Wellness Programs: Incentives for Non-Use of Tobacco, Activity-Based Alternatives

By Bill Olson

On January 9, 2014, the Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Department of the Treasury/IRS issued Frequently Asked Questions - Part XVIII that provides additional information about requirements in several areas. In this third of a three-part series, we will address some clarifications related to wellness programs.

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Tip Tuesday! Final Regulations Issued on Section 6056 Reporting of Health Insurance Coverage

By ADP

As mentioned in recent editions of Eye on Washington, there has been a flurry of activity regarding the Affordable Care Act (ACA). On March 10, 2014, the Internal Revenue Service (IRS) published long-awaited final regulations regarding employer information reporting concerning health insurance coverage offered under employer-sponsored plans, under Section 6056. This Eye on Washington provides a brief overview of highlights and key elements of this reporting, and noteworthy changes from the proposed regulations.

As background, Applicable Large Employers (ALEs) must file annual returns with the IRS to report the healthcare coverage offered to full-time employees^[1] and their dependents. An ALE is an employer that employed (aggregated with members of its controlled group) an average of at least 50 “full-time employees” (including “full-time equivalent employees” (FTEs)) on business days during the preceding calendar year.

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Simplified employer health care coverage reporting announced

By Sally Schreiber

On Wednesday, the IRS released final regulations to implement simplified reporting requirements under the Patient Protection and Affordable Care Act, P.L. 111-148, which requires employers to report health care coverage information under Secs. 6055 and 6056 starting in 2015 (T.D. 9660 and T.D. 9661).


Also Wednesday, the Department of Health and Human Services (HHS) released several PPACA-related standards, including an additional two-year grandfathering period for certain health plans in the small group and individual health insurance markets that do not meet the act’s minimum coverage requirements. The extension applies to policy years beginning on or before Oct. 1, 2016.

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New FMLA ruling could open door to administrative chaos

By Jared Bilski

For employers, determining whether an employee’s absence(s) should be designated as FMLA leave is already tricky enough. But a recent court ruling could complicate this process even further.

The case we’re referring to is Escriba v. Foster Poultry Farms, and experts like employment attorney and FMLA Insights founder Jeff Nowak are already predicting this will be one of the most important FMLA cases of the year.

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What you need to know about the ACA’s final ‘play-or-pay’ reporting rules

By Christian Schappel

Almost four years after the Affordable Care Act (ACA) was signed into law, the IRS has finally released the reporting requirements employers must comply with to avoid the dreaded ‘play-or-pay’ penalty (a.k.a., the shared responsibility penalty).

If you recall, the IRS issued the proposed play-or-pay reporting rules last September.

On the whole, the final rules are pretty much the same. But the IRS has squeezed in a few new elements it hopes will simplify the reporting process for employers and insurers.

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Tip Tuesday! Smaller businesses get another break from Obamacare mandate

By Christian Schappel

If you thought delaying the employer mandate until 2015 was a relief, wait until you see what the Obama Administration’s done now.  

It has essentially decided to veer off course from that delay.

Instead, the administration’s decided to implement a new two-phase installation of the mandate, which will eventually require all employers with 50 or more “full-time equivalent” employees to provide “affordable” health insurance to 95% of those employees or pay federal penalties.

The new phase-in looks like this:

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Firing for bad attitude doesn’t violate labor law, NLRB says

By Tim Gould

You often hear managers whining about how “you can’t fire somebody for a bad attitude.” That’s wrong — and a recent National Labor Board ruling actually confirms that.

A three-member panel of the NLRB recently issued a decision concerning Copper River, a restaurant in Boiling Springs, SC. Two employees had complained that they were fired because of earlier efforts to organize employees there.

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For the love of leisure: Why you need your R & R

By Arleen Fitzgerald

You work hard. But, how are you at relaxing? It should be easy, right?

When we're busy, it can be tough to unwind. We'd like to and hope to … when we get around to it. But, relaxation and recreation are more than wants — or wishes. They're essentials for your well-being.

When you enjoy your downtime — free from work or duties — it offers an emotional lift that gives you energy and confidence to tackle everyday challenges. And, losing yourself in leisure may even decrease harmful stress-related hormones and strengthen your immune system.

The bottom line: You can be happier, healthier and more productive when you take time for leisure.

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Tip Tuesday! BREAKING NEWS - IRS, HHS RELEASE ADDITIONAL FINAL REGULATIONS

By Bill Olson

On March 5, 2014, the Department of the Treasury and the Internal Revenue Service released the final employer-shared responsibility ("play or pay") reporting rules. The Patient Protection and Affordable Care Act (PPACA) requires reporting in support of the individual and employer-shared responsibility requirements and premium tax credit/subsidy eligibility, under Sections 6055 and 6056 of the Internal Revenue Code. Fully insured employers with fewer than 50 full-time or full-time equivalent employees generally will not need to report. Larger insured plans and all self-funded plans will need to file reports. The final rule will permit use of a single form to fulfill reporting obligations under both parts of the law.

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Surprise in Obamacare’s waiting period rules could be used to your advantage

By Jared Bilski

Lost in the wake of all the hullabaloo about further delays of the Affordable Care Act’s (ACA) employer mandate was another important rule clarification.

The feds just issued the final rule on employee waiting periods for healthcare coverage under the ACA, and they added a proposal that may very well allow health plans to extend the total waiting period beyond the 90-day maximum.

The bulk of the final rule is consistent with the proposed regs the feds had issued previously, and simply clarifies some of the finer points of the law.

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Using independent contractors: 5 things you need to read right now

By Christian Schappel

The compounding effect of five developments in employment law has made using independent contractors significantly more appealing and risky at the same time.

The independent contractor marketplace has become a powder keg, and employers need to be aware of new tripwires that have been established that could make it blow up in their faces.

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Feds boost efforts for ACA sign-ups, penalty communication

By Alex Wayne

Bloomberg) — Facing an end-of-the-month deadline, the U.S. government is increasing efforts to enroll millions more Americans into Obamacare, including appeals from President Barack Obama and his wife, Michelle.

The Obama administration also is developing a strategy to communicate to Americans the penalty for going without insurance after March 31. People without insurance face fines of as much as 1% of their income, a penalty that hasn’t been mentioned in the government’s advertising.

About 4 million Americans have so far signed up for private health plans under the Affordable Care Act. As many as 3.5 million more have enrolled in Medicaid, according to Avalere Health, a Washington-based consulting firm. The administration’s success signing up more people in the last month of enrollment will have repercussions for insurers, who must set rates for 2015 by the end of May, and in congressional elections this November.

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New Obamacare regs: Dependents you no longer have to cover

By Jared Bilski

Delays of the play-or-pay penalties weren’t the only relief to come out of the feds’ final rules on the “shared-responsibility” mandate.

The final rules also include a significant amount of relief in terms of dependent-care coverage.

Originally, for pay-or-play purposes, the feds had defined the term “dependents” to include biological children, stepchildren, adopted children and foster children.

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