IRS Announces 2020 ACA Affordability Indexed Amount

August 22nd, 2019

The IRS recently announced in Revenue Procedure 2019-29 that the Affordable Care Act (ACA) affordability indexed amount under the Employer Shared Responsibility Payment (ESRP) requirements will be 9.78% for plan years that begin in 2020. This is a decrease from the 2019 percentage amount (9.86%).


Rev. Proc. 2019-29 establishes the indexed “required contribution percentage” used to determine whether an individual is eligible for “affordable” employer-sponsored health coverage under Section 36B (related to qualification for premium tax credits when buying ACA Marketplace coverage). However, the IRS explained in IRS Notice 2015-87 that a percentage change under Section 36B will correspond to a similar change for affordability under section 4980H ESRP requirements.

Determining Affordability in 2020

An employer will not be subject to a penalty with respect to an ACA full-time employee (FTE) if that employee’s required contribution for 2020 for [...]

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IRS Expands Preventive Care for QDHDPs

August 6th, 2019

On June 24, 2019, the President issued an Executive Order directing the Department of the Treasury and the IRS to issue guidance that expands the ability of HSA-qualifying high-deductible health plans (QHDHPs) to cover low-cost preventive care that helps maintain health status for individuals with chronic conditions before the statutory minimum deductible for QHDHPs has been met. In response, on July 17, 2019, the Treasury Department and IRS issued Notice 2019-45 expanding the list of preventive care benefits.

Briefly, the following services and items are treated as preventive care when:

  • prescribed to treat an individual diagnosed with the associated chronic condition (as specified in the IRS guidance),


  • prescribed for the purpose of preventing the exacerbation of the chronic condition or the development of a secondary condition.

Preventive Care for Specified Conditions


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New Executive Order Addresses Healthcare Issues

July 17th, 2019

On June 24, 2019, President Trump issued an Executive Order (“EO”) directing the relevant federal agencies to issue regulations or other guidance to make available more meaningful information related to the price and quality of healthcare.

This summary highlights aspects of the EO that may be relevant to employer-sponsored group health plans and their covered participants.

  • By October 22, 2019, the Treasury shall issue guidance to expand the ability of patients to select a qualified high deductible health plan (“QHDHP”) that can be used alongside a health savings account (“HSA”), and that cover low-cost preventive care, before the deductible, for medical care that helps maintain health status for individuals with chronic conditions. This may provide first dollar coverage of more items and services for individuals with a QHDHP, particularly as it relates to individuals with chronic conditions (e.g., diabetes).
  • [...]

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Important Update from Blue Shield of California

February 26th, 2019

Whether you’re a Blue Shield member or insured with another carrier, this recommendation is based on clinical guidelines from the Centers for Disease Control and Prevention (CDC). The CDC is a federal office in charge of health promotion and disease prevention in the US.

Click here to view the full update.

“We have included guidelines for routine exams, screenings, and immunizations. These are based on clinical guidelines from the Centers for Disease Control and Prevention (CDC). The CDC is a federal office in charge of health promotion and disease prevention in the United States.

“We recommend that you take these guidelines with you to your next doctor’s appointment. You can ask for your doctor’s view on which exams and screenings you or your loved ones may need this year.”

Proposed Rules Address Prescription Drug Pricing

February 13th, 2019

Last week, the Department of Health and Human Services (“HHS”) released a proposed rule to lower prescription drug prices and out-of-pocket costs by encouraging manufacturers to pass discounts directly to patients and bring new transparency to prescription drug markets.


  • Nothing has changed. This is a proposed rule.
  • Even if finalized in its current form, the proposed rule does not impact employer-sponsored plans unless Pharmacy Benefit Managers (“PBMs”) and pharmaceutical manufacturers adopt a new safe harbor (discussed below), which may provide additional transparency.


Under the federal Anti-Kickback Statute (“AKS”), the federal government may impose criminal and civil penalties on whoever “knowingly and willfully offers, pays, solicits or receives remuneration to induce or reward the referral of business reimbursable under any of the federal health care programs” (e.g., Medicare, Medicaid). Generally, employer-sponsored health plans are not “federal health [...]

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Reminder: OSHA 300A Forms Must Be Posted by February 1 and New Final Rule Released

February 1st, 2019

The Occupational Safety and Health Administration (OSHA) mandates that all employers who are required to maintain the OSHA 300 Log of Work-Related Injuries and Illnesses post a summary of the previous year’s log between February 1st and April 30th each year, even if no incidents occurred in the preceding calendar year. The summary (OSHA Form 300A) must be certified by a company executive and posted in a conspicuous location where notices to employees are customarily posted.

All employers who had more than ten employees at any point during the last calendar year are covered by this requirement unless they qualify as part of an exempt low-risk industry. A full list of the industries exempt from OSHA routine recordkeeping requirements (including posting Form 300A) can be found in the Guides section of the HR Support Center by searching “partially exempt industries.” [...]

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2019 Health Plan Compliance Deadlines

January 30th, 2019

Employers must comply with numerous reporting and disclosure requirements throughout the year in connection with their group health plans. This Compliance Overview explains key 2019 compliance deadlines for employer-sponsored group health plans. It also outlines group health plan notices that employers must provide annually. Often, employers furnish these notices with the plan’s enrollment materials during its annual open enrollment period.

Read the Compliance Overview.

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How the Government Shutdown is Affecting Employers

January 18th, 2019

The current partial government shutdown — which has been in effect since Dec. 22, 2018 — is the longest shutdown in U.S. history. Unlike past shutdowns, the government is not completely closed. However, due to the prolonged nature of the shutdown, employers are starting to feel its effects. This article provides an overview of how the shutdown is affecting private employers in the United States.

Read the full News Brief here.

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2019 Minimum Wage Rates

January 7th, 2019

The current federal minimum wage rate is $7.25 per hour. However, many states have adopted minimum wage rates higher than the federal rate. When the state rate and the federal rate are different, employers must pay their employees the higher rate.

The following states have adopted new minimum wage rates for 2019:

  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Delaware
  • Florida
  • Maine
  • Massachusetts
  • Minnesota
  • Michigan
  • Missouri
  • Montana
  • New Jersey
  • New York
  • Ohio
  • Oregon
  • Rhode Island
  • South Dakota
  • Vermont
  • Washington
  • Washington D.C

Click here to download the rates.

Action Steps

Affected employers should review their employees’ pay rates and update their minimum wage poster notices as necessary to ensure compliance with local wage and hour regulations.

Important Dates

December 31, 2018
New minimum wage rate effective in New York.

January 1, 2019
New minimum wage rates [...]

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Blue Shield of California Offers Assistance to Members Affected by California Wildfires

November 14th, 2018

Date: November 9, 2018

Attn: Core and Premier Accounts

There are a number of wildfires underway in California.   We are working hard to ensure the safety and care of all Blue Shield of California members. 

Mandatory evacuations have been ordered for: 

  • The Hill Fire (Ventura County) is at ~10,000 acres in size. Mandatory evacuations are in zip codes, 93010, 93012, and 93066. New zip codes affected are 93041, 93033, and 91320.
  • New Woolsey Fire (LA and Ventura County is at 8,000 acres in size. Mandatory evacuations are in 91361, 91362, 91301, 91302, 91367, 91377, 90265, 90263, 91307, 91360, and 93065.
  • The Camp Fire (Butte County) is 20,000 acres in size.  Mandatory evacuations are in zip codes 95969, 95965, 95967, 95928, and 95954. New zip code 95978.

Blue Shield’s response to fires:

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