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Health Care Reform

 

Alternative Care Act – PPACA

PPACA has changed the way we offer health care programs. Grandfathered rules, Age 26 Dependents, Essential Benefit Determinations; It’s very complex, and mistakes can be costly. If you are a Grandfathered Plan, you must make certain you do not lose your status. Count on us to assist you. As your employee benefit specialist team, we make it our responsibility to assist you with compliance. Tens of thousands of pages on PPACA and other regulatory matters exist or are pending and soon to be released. Let us help you. There is no need to be overwhelmed. Let us help to educate you and assist you overall with all phases of compliance.

 

 

ACA’s PCOR Fee For Self-Funded Health Plans

Due July 31, 2017

Patient-Centered Outcomes Research Institute Fee

The Affordable Care Act imposes a fee on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to help fund the Patient-Centered Outcomes Research Institute. The fee, required to be reported only once a year on the second quarter Form 720 and paid by its due date, July 31, is based on the average number of lives covered under the policy or plan.

The fee applies to policy or plan years ending on or after Oct. 1, 2012, and before Oct. 1, 2019. The Patient-Centered Outcomes Research Institute fee is filed using Form 720, Quarterly Federal Excise Tax Return. Although Form 720 is a quarterly return, for PCORI, Form 720 is filed annually only, by July 31.

Please refer to the following chart for the filing due date and applicable rate depending upon the month a specified health insurance policy or an applicable self-insured health plan ends.

For complete information, you can visit the IRS website at:
http://www.irs.gov/uac/Newsroom/Patient-Centered-Outcomes-Research-Institute-Fee

HHS Finalizes Rule to Improve Health Equity Under the Affordable Care Act

Patient-Centered Outcomes Research Institute Fee

On May 13, 2016, HHS released the final rule prohibiting discrimination based on race, color, national origin, sex, age, or disability; enhances language assistance for individuals with limited English proficiency; and protects individuals with disabilities under Section 1557.

Under the rule, individuals are protected from the discrimination in health care on the basis of race, color, national origin, age, disability, and sex, including discrimination based on pregnancy , gender identity and sex stereotyping.

For more information, including a Summary of the Rule, Fact Sheets on Key Provisions, and FAQ’s on the final rule, click here.

IRS Releases “Cadillac Tax” Guidance on the 40% Excise Tax on High-Cost Employer Sponsored Health Coverage

Click Here for Notice 2015-16

ACA Employer Reporting Draft Forms Released

In July, 2014, the IRS released the Draft Employer Reporting Forms for the Affordable Care Act. All Applicable Large Employers (ALE’s) with 50 or more employees will need to report detailed information on the employer, the employees, the health plans you offer, whether or not you meet Minimum Essential Coverage (MEC) and Affordability Requirements. Even mid-size employers (50-99) who may qualify for a delay of the Large Employer Mandate will need to report, in order to qualify for the employer large group health plan requirements under ACA. If you do not properly track your reportable information, you will NOT qualify for the one-year delay of having to offer health coverage to your employees (proper reporting allows you to put off offering coverage or paying penalties for one year, until 2016).

Note that the forms released are DRAFT forms. The final forms, nor the instructions, have been released at this time.

To download the ACA Employer Reporting Forms, click here.

ABC clients can learn more about the ACA’s requirements through our video presentations on the Affordable Care Act. Clients only. User name and password required. Click here if you’re a client and would like to review the employer training video.

Obamacare News Archive 

On Monday, February 10, 2014, the Obama Administration announced a delay of the Employer Mandate, requiring that they offer health insurance to full-time employees under the Affordable Care Act (ACA) for large employers with 50-99 employees for one year (2016). According to the announcement, this delay has no impact on the employers with 100 or more employees; large employers with 100+ employees must comply with the large employer pay or play mandate by January 1, 2015. Small employers with less than 50 employees are not required to offer coverage. More information will be posted as it becomes available.

>> Download the Employer Shared Responsibility Fact Sheet 2-10-14 from the US Dept of Treasury.

ABC Benefit News! – Read Our Employee Newsletter Series

ACA Employer Mandate for Employers with 50 or More Employees Reporting Requirements Delayed One Year

On July 2nd, Mark J. Mazur, Assistant Secretary for Tax Policy at the U.S. Department of Treasury announced in a blog post a one year delay in the mandatory employer and insurer reporting requirements under ACA. “We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively. We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so. We have listened to your feedback. And we are taking action.”

The Department of Treasury released guidance on this delay in Notice 2013-45, which basically states (in summary):

  • “Both the information reporting and the Employer Shared Responsibility Provisions will be fully effective for 2015.” – The notice does not specifically address transition relief that had already been allowed for 2014 for employers contributing to multiemployer plans, for those that do not yet fully offer dependent coverage, and for those who have off-calendar plan years, including whether or not that transition relief will be extended into 2015. However, the wording “fully effective” and the fact that the notice deliberately did not extend existing transition relief into 2014 is telling.
  • “Proposed rules for the information reporting provisions are expected to be published this summer.” – The National Association of Health Underwriters (NAHU) has heard that these rules are expected LATE summer and is expecting this in September. Also, the Department of Treasury has indicated to NAHU that they plan to gather input from stakeholders regarding the details of the proposed rule before they are issued, including from NAHU and their coalition partners.
  • “Once the information reporting rules have been issued, employers and other reporting entities are encouraged to voluntarily comply with the information reporting provisions for 2014.” “Real-world testing of reporting systems and plan designs through voluntary compliance for 2014 will contribute to a smoother transition to full implementation for 2015.” NAHU encouraged its members after the release of this Guidance to meet with their employer clients immediately on these changes and continue with good-faith compliance efforts regarding the employer shared responsibility requirements and reporting provisions during the coming year. This extra compliance time can be used to better help clients make sound business decisions regarding the requirements without the risk of significant financial penalties in the first year of changed operations.
  • “Individuals will continue to be eligible for the premium tax credit by enrolling in a qualified health plan through the Affordable Insurance Exchanges (also called Health Insurance Marketplaces) if their household income is within a specified range and they are not eligible for other minimum essential coverage, including an eligible employer-sponsored plan that is affordable and provides minimum value.”While the exchange-based subsidies will be awarded based on self-reported and voluntarily collected data in 2014, the guidance does make it clear that if an individual has a valid offer of affordable and minimum value employer-sponsored coverage, they will technically not be qualified for exchange-based individual subsidies to begin on January 1, 2014. Individuals who receive a subsidy inappropriately may ultimately face personal tax consequences too. Therefore, education of employees and the information employers provide to their employees about the status of their existing employer-based coverage and whether or not it meets the definition of minimum value and/or minimum essential coverage via 2013-2014 SBCs and the exchange notices are critical.
  • “This transition relief through 2014 for the information reporting and Employer Shared Responsibility Provisions has no effect on the effective date or application of other Affordable Care Act provisions.“ There are lots of provisions of the law that relate to the employer mandate requirements and reporting requirements, but aren’t contingent on them. Unless we hear otherwise through some type of other major announcement, those requirements and provisions of the law continue on unaffected. Provisions and requirements this guidance does not impact include, but are not limited to:
    • The law’s health insurance market reforms that go into effect as of the first day of the plan year that begins in 2014. For example, these reforms include rating changes in the individual and small group markets, out-of-pocket limits for all markets, prohibitions on waiting periods of more than 90 days for all plans and many more.
    • Individual mandate. The IRS will monitor compliance with the individual mandate through self-certification on each individual’s tax return.
    • Health insurance exchanges. President Obama publicly affirmed on Monday that open enrollment is still expected to begin on October 1, 2013 for all state-based, partnership and federally facilitated marketplaces.
    • The marketplace notice. Unless the administration issues an additional delay, all employers subject to the Fair Labor Standards Act (not just PPACA’s employer mandate provisions) are required to send a marketplace notice to all employees by October 1, 2013. Also, the plan affordability/minimum value information required to be provided in the notice is still required. Affordability/minimum value are not concepts limited to the employer mandate provisions of the law—they are concepts relevant to ANY employee (part-time, full-time, temporary, seasonal, etc) of ANY employer (regardless of size) who is eligible for employer sponsored coverage and who wishes to apply for a subsidy in the exchange.
    • Summaries of Benefit and Coverage. Unless we receive additional guidance that indicates otherwise, the notices for the coming plan year must include information about whether or not a plan meet the minimum value or minimum essential coverage standards. These standards relate to the employer mandate provisions in the law, but they aren’t limited to it, and the SBC requirements are also unaffected by yesterday’s announcement.
    • PCORI Fee. The first payment of this fee is due by July 31, 2013 for calendar year plans or a plans with year that ended in October or November of 2012. For fully-insured plans, the issuer will pay this fee, but for self-funded arrangements or plans that include both a full-insured and self-funded component, the payment responsibility lies with the employer.
    • The transitional reinsurance fee and the new national health insurance premium tax. Both will be built into 2014 premiums. Other new taxes, like the medical device tax and pharmaceutical tax will also continue and impact coverage costs.
    • W-2 Reporting requirements. These still apply for employers that issue more than 250 W2s.
    • The limit on Health FSA salary reductions.

The California Department of Insurance (Dave Jones, Insurance Commissioner) released a press release shortly after the IRS blog post stating that employees of employers who do not provide health insurance will be able to purchase health insurance in California’s new health benefit exchange, and that many will be eligible for a premium subsidy.

For a copy of the IRS blog, click here.

For a copy of the Department of Insurance Press Release, click here.

For a copy of Notice 2013-45, click here.