1. health and fitness

HCR TRACKER UPDATE: May 2015
Reminder: Stay Informed on Health Care Reform Updates
Please remember that as an M3 client, you can login and view the Health Care Tracker at any time on M3Connect.
In addition, you receive regular monthly updates to help you stay informed about the latest changes in Health Care
Reform. Click here for previous monthly updates. Please join us for a webinar on WEDNESDAY, May 27, 2015 to
discuss current issues as well as some reminders on upcoming compliance obligations.
What’s New in May 2015
The Affordable Care Act (ACA) has been on the books for 5 years!! Again this year, several key provisions will be
implemented. You can continue to rely on M3 to provide you with the most up-to-date and accurate information
as we steer through yet another year! Please see below for important and up-to-date information and reminders
on HCR hot topics in May.
New! ERISA Section 510 Claim Filed – ACA Reduction in Hours Strategy
On May 8, 2015, a class action lawsuit was filed against Dave & Buster’s Inc. for acts of discrimination under ERISA
s. 510, 29 USC §1140 in the United States District Court, Southern District of New York. The plaintiff/class allege
that they were participants in Dave & Buster’s health insurance plan and their hours were involuntarily reduced
after the enactment of the ACA and the reductions resulted in the loss of insurance coverage or an offer of inferior
health insurance.
The plaintiff/class seek to have the court determine whether or not Dave and Buster’s “right sized” its work force to
reduce the number of full-time employees and whether they “right sized” their work force for the purpose of
avoiding the costs associated with providing health insurance to full-time employees. The alleged facts in the case
indicate that at one Dave & Buster’s location the store manager announced that compliance with the ACA was too
costly and therefore the number of FT employees at the location would be reduced by 40%.
ERISA 510 states it is unlawful for any person to discriminate against a participant or beneficiary for exercising any
right to which he is entitled under the provisions of an employee benefit plan.
We will keep you posted as this case or other cases develop. Please click here for a copy of the complaint.
Update! Cash-in-lieu Options and Affordability
On November 6, 2014, the DOL issued FAQs regarding an employer’s ability to provide reimbursements for
individual health insurance policies. The FAQ also addressed cash-in-lieu options provided to high claims risk
employees and stated that such arrangements would constitute discrimination based on an adverse health
factor. In addition, the DOL states that it results in a situation in which the employee must “accept the cost of
forgoing the cash in order to elect plan coverage.” As such, the guidance suggests that the cost of health plan
coverage must include the cash-in-lieu offered as well as the premium cost.
Informal comments made by IRS officials suggest that this would apply to ALL employees who are offered cash-inlieu rather than the high claims risk employees as addressed in the FAQ. To date, the IRS has not issued anything
formal to clarify. If you currently offer cash-in-lieu, you may have to add the amount of cash offered to the
employee’s share of the lowest single coverage premium to determine affordability.1 Stay tuned.
1
This applies only to employers who are subject to the Employer Shared Responsibility requirements.
HCR TRACKER UPDATE: May 2015
Reminder! Cadillac Tax – Request for Comments
The Department of the Treasury (Treasury) and the Internal Revenue Service (IRS) recently issued Notice 2015-16.
This Notice describes potential approaches to future regulations and requests comments on the approaches.
Specifically, the Notice focuses on the following issues:
 The definition of applicable coverage
 The determination of the cost of applicable coverage
 The application of the annual statutory dollar amount limit to the cost of applicable coverage.
After the departments receive comments they anticipate publishing proposed regulations. The proposed
regulations will also provide an opportunity for comment.
Please click here for the M3 Fact Sheet on the Cadillac Tax and IRS Notice 2015-16.
Reminder! Section 6055/6056 Reporting Requirements
In March 2014, final regulations were issued regarding the large employer reporting requirements under Sections
6055 and 6056. The reports will be due from large employers by March 31, 2016 for the 2015 calendar year.
All employers will be expected to use IRS forms 1095c and 1094c for these reporting requirements. Employers will
also be expected to provide employee statements to employees by January 31 for the preceding calendar year. The
first distribution of employee statements will be in 2016 for calendar year 2015. Forms for TY 2014 were issued
earlier this month.
If you currently sponsor a fully insured plan, you may receive a request from your carrier to provide Social Security
Numbers (SSNs). Carriers are required to provide this information when listing covered individuals for 6055 reporting
purposes.
Employers that offer a retiree-only HRA will have to complete the 6055 reporting, which gives the IRS information on
who is offered minimum essential coverage. We anticipate that employers will use a 1095b for this reporting
requirement.
Please click here for the 2014 forms, instructions and an informative brochure from the IRS.
HCR Resources available to you:
 Your M3 Account Executive is always your first resource for information.

M3’s online Health Care Reform Tracker with important dates and easy-to-use information and interface

Monthly email updates of key Health Care Reform Changes. If you are not receiving these monthly email
updates, please ask your M3 Account Executive to add you to the list.