BSI Corporate Benefits is committed to proactively supporting our clients with Health Care Reform (HCR) Compliance. We develop specific action plans for each client based on their current situation. As your employee benefits consultant, it is our responsibility to ensure we understand the laws and ensure your company is compliant.

U.S. Department of Health and Human Services

http://www.hhs.gov/

Patient Protection and Affordable Care Act (PPACA)

http://www.ncsl.org/documents/health/ppaca-consolidated.pdf

HealthCare.Gov

IRS

http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions

NEW: IRS Affordable Care Act Tax Provisions

http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home

White House

Department of Labor – Health Care Reform

http://www.dol.gov/ebsa/healthreform/

FAQ The ACA Implementation Part XVIII

The United States Justice Department –Affordable Care Act

http://www.justice.gov/healthcare/

Medicare.gov – Affordable Care Act

http://www.medicaid.gov/AffordableCareAct/Affordable-Care-Act.html

Department of Health and Human Services

Women’s Preventative Service Required Health Plan Coverage

U.S Department of The Treasury

Fact Sheet on Proposed Affordable Care Act Regulations
BSI Corporate Benefits is licensed with over 50 insurance carriers nationwide. Most insurance carriers provide tools and information on Health Care Reform compliance. BSI ensures that a client’s current/prospective insurance carrier information is evaluated and included in their tailored Health Care Reform action plan. We also provide monthly Health Care Reform newsletters to communicate and highlight important compliance information.

Major Insurance Carriers – Health Care Reform Links:

Insurance Carriers - Health Care Reform News:

October 19, 2015

Hotline for Reinsurance Fee Submission

The Centers for Medicare and Medicaid Services will host a hotline to help contributing and reporting entities complete the 2015 Transition Reinsurance Program Annual Enrollment and Contributions Submission Form.

Remember: Whether an employer is paying the Reinsurance Assessment Fee in one or two installments, the employer must submit the 2015 Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form and schedule payment no later than Nov. 16, 2015 (as Nov. 15 is a Sunday). The first installment deadline is Jan. 15, 2016, and the second installment deadline is Nov. 15, 2016. Plan sponsors can also pay the fee in full by the deadline of the first installment.
Click here for full article

October 8, 2015

Employers to Receive Reinsurance Fee Mailing

This week, employers with a self-funded health plan administered by Starmark® who are required to pay the Reinsurance Assessment Fee will receive a letter providing their group’s “average number of covered lives” (using the Snapshot Count method). The letter will also be available in the Starmark Document Center. As a courtesy, the Broker of Record will receive a duplicate copy of the letter.

The Patient Protection and Affordable Care Act introduced the Reinsurance Assessment Fee to fund a three-year reinsurance program. The program is designed to reimburse companies that insure high-cost patients through the individual health insurance marketplace. The fee, assessed from 2014 through 2016, affects fully insured and self-funded health plans.
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October 5, 2015

Big PPACA changes could come in 2017

A little-known part of the Patient Protection and Affordable Care Act that goes into effect in 2017 could eventually change how the law works in many states. Beginning in 2017, Section 1332 will allow the federal government to grant waivers to states allowing them to revise key parts of the law. For example, states could potentially be given the right to get rid of their insurance exchanges or eliminate the individual or employer insurance mandate. Or, states could be authorized to create a single-payer health system, as Vermont tried unsuccessfully to do.
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October 2, 2015

Small Group Definition Will Not Change Nationally in 2016 - States Have Flexibility

On October 1, Congress approved a bill repealing the Affordable Care Act (ACA) provision expanding the small group employer definition, which was scheduled to change from 1-50 to 1-100 employees on January 1, 2016. President Obama is expected to sign the bill into law next week. The repeal legislation, the Protecting Affordable Coverage for Employers (PACE) Act, maintains the current 1-50 employee definition of a small employer and gives states flexibility to expand the small employer definition up to 100 employees if they determine market conditions necessitate the change.

The District of Columbia and several states – CA, CO, MD, NY, VA and VT – have enacted laws or issued regulatory guidance changing their small group definition to the 1-100 employee definition in 2016.* With the repeal of this ACA provision, these states may revise their laws/regulatory actions to, once again, conform to the federal definition of small employer. Until then, these laws/regulatory actions remain in effect.
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September 30, 2015

Affordable Care Act Cost-Sharing and High Deductible Health Plan Limits for 2016

Starmark® self-funded plan designs’ in-network out-of-pocket limits have been updated to incorporate the 2016 ACA cost-sharing and high-deductible health plan changes. The in-network out-of-pocket limits for 2016 plan years are:
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September 28, 2015

Health Care Reform - Aetna

New Kaiser Family Foundation research found that single and family premiums for employer-sponsored health insurance in 2015 rose by an average of 4 percent, consistent with the modest increases seen over the past decade. But the survey also found that workers’ out-of-pocket costs are rising at a much faster rate, with a 67 percent increase in deductibles since 2010.
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September 18, 2015

Final 2015 Forms and Instructions for IRS Reporting Requirements

On September 17, the Internal Revenue Service (IRS) released final forms and instructions to be used for Affordable Care Act (ACA) Minimum Essential Coverage (MEC) and Applicable Large Employer reporting, first due in January 2016 for coverage offered in calendar year 2015. This includes final versions of:

  • Forms 1094-C and 1095-C (for Applicable Large Employer reporting and self-insured large group MEC reporting)
  • Forms 1094-B and 1095-B (for insurance carrier and small employer MEC reporting)
  • The accompanying instructions

There are minor changes to some of the forms and both sets of instructions.
Click here for full article

August 24, 2015

New FAQ Available to Help Answer 6055 and 6056 Questions

A new frequently asked questions document about 6055 and 6056 reporting requirements is available for brokers in the Healthcare Reform toolkit. The flyer answers some of the most common questions about the Affordable Care Act, the reporting process, and how Starmark is helping. It also includes additional resources for more information.
Click here for full article

August 11, 2015

Draft Instructions and Revised Draft 2015 Forms for IRS Reporting Requirements

On August 7, the Internal Revenue Service (IRS) released draft instructions and revised draft 1095-B and 1095-C forms to be used for Affordable Care Act (ACA) Minimum Essential Coverage (MEC) and Large Employer reporting in 2016. The IRS has posted the 2015 draft instructions and forms at IRS.gov/draft forms as information only, and will post final versions at a later date. The revised 2015 draft forms are generally unchanged from the versions released on June 19, 2015. However, the IRS made several changes to the 2014 final instructions, including:
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August 3, 2015

IRS provides guidance on calendar year 2016 High Deductible Health Plans Out-of-Pocket Maximum Limits, Minimum Deductible Levels and Health Savings Account Contribution Limitations

On May 4, 2015, the Internal Revenue Service (IRS) released calendar year 2016 out-of-pocket (OOP) maximum limits and minimum deductible amounts for high deductible health plans (HDHPs). For calendar year 2016, the OOP maximum limits will be:

  • $6,550 for self-only coverage (up from $6,450 in 2015)
  • $13,100 for family coverage (up from $12,900 in 2015)

Please note: Due to a difference in annual adjustment criteria, the OOP levels for HDHPs are lower than the OOP levels required of individual ($6,850), and small, large group and self-funded coverage ($13,700) in 2016 under the Affordable Care Act. There is no change to the HDHP minimum deductible levels for calendar year 2016:

  • $1,300 for self-only coverage
  • $2,600 for family coverage

Click here for full article

July 31, 2015

Second 40% Excise Tax ("Cadillac Tax") Notice Issued

On July 30, the Department of the Treasury and the Internal Revenue Service (IRS) issued a second notice regarding the 40% Excise Tax a.k.a. the Cadillac Tax. The notice provides information on possible approaches that are being considered for administering the Cadillac Tax and continues the process of gathering input that will be used to develop regulations. The 40% Excise Tax a.k.a. “Cadillac Tax” The Cadillac Tax is a 40% excise tax scheduled to take effect in 2018 to reduce health care usage and costs by encouraging employers to offer cost-effective plans that engage employees in sharing in the cost of care. The tax impacts plans exceeding the following thresholds, which will be adjusted annually for inflation: $10,200 for individual coverage $27,500 for family coverage This is a follow-up to the notice issued on February 23, 2015, and comments may be submitted until October 1, 2015.
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July 21, 2015

New Presentations Available about 6055 and 6056 Reporting Requirements

Two new presentations are available in the Healthcare Reform toolkit to help explain the 6055 and 6056 reporting requirements. The presentations explain the requirements, who must comply, details of what the reports must contain, reporting deadlines, and more.
Click here for full article

July 7, 2015

Reporting Requirements: Increased Penalties and New Electronic Filing Steps

The Trade Preferences Extension Act of 2015 (“Act”), signed into law by President Obama on June 29, significantly increases potential penalties for insurers and employers that fail to comply with the new Affordable Care Act (ACA) Minimum Essential Coverage (MEC) and Large Employer reporting requirements first due in 2016.
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June 22, 2015

Mercer Survey Looks at Impact of Employer Mandate on Enrollment in Employer-Sponsored Plans

Mercer’s latest survey on health reform, Health Reform Five Years In, asked employers about open enrollment results for 2015 to determine the impact of the employer mandate on employer-sponsored plans. The survey examined how the Affordable Care Act (ACA) is affecting workforce strategy, and asked about employers’ preparations for avoiding the excise tax on high-cost plans in 2018, and for meeting ACA reporting requirements.
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June 15, 2015

Health Reform Weekly - Aenta

A new Urban Institute study has found that the percentage of workers offered health insurance coverage through their employers has remained unchanged under the Affordable Care Act (ACA). Some critics warned that the law would result in an erosion in employers who offer health benefits to employees, but the study’s authors predict that coverage rates will remain stable in the coming years.
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June 2, 2015

How the ACA Affects Health Insurance When Your Employees Transfer to a New Office

Managing health insurance in one state is complicated enough. It’s even more difficult when your company has offices in different states, because every state has its own market and unique regulations for health insurance. This makes it confusing for both employees and employers whenever a worker transfers to an office in another state. The good news is the Affordable Care Act has set some national standards for group health insurance plans so that there are fewer differences between states. Still, some changes might come up that both you and your employee should prepare for.
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May 28, 2015

Using Big Data Analysis to Improve Wellness Program

As an employer, you want to encourage good health and lower costs for your employees through the use of a wellness program, but it’s difficult to determine if your program is actually effective. Some people use it and some don’t, making it hard to evaluate the overall picture. By looking at big data, however, you have a way to better understand what’s working and what isn’t. Better information might spur you to sponsor a different support group, exercise club or new activity to make a bigger impact on your company’s staff.
Click here for full article

May 26. 2015

5 Ways to Save on Health Insurance

Every business wants to spend less on health coverage, but accomplishing that is much easier said than done. There are, however, some actions you can take that will help you breathe a bit easier when it comes time to write the check. Here are five ways to save on health insurance costs:
Click here for full article

April 1, 2015

New Summary of Benefits and Coverage Template Delayed

A March 30 Department of Labor (DOL) FAQ announced that the new Summary of Benefits and Coverage (SBC) template and related documents, published in proposed regulations on December 22, 2014, are delayed until 2016. However, some changes to the regulation will apply in 2015, as planned.
The FAQ indicates final regulations are expected in the near future.
Delayed until 2016

Per the FAQ, the new SBC template will go through consumer testing. The DOL anticipates that the document will be finalized in January 2016, and will apply to 2017 coverage. Use will likely begin during fall 2016 open enrollment for plan years beginning on or after January 1, 2017. Expected changes to the template include, but are not limited to:
Click here for full article

March 31, 2015

SBC Changes Delayed

The proposed deadline for providing revised Summaries of Benefits and Coverage and Glossary of Terms (collectively, SBC templates) to health plan members has been delayed. In December 2014, the U.S. Departments of Labor, Health and Human Services and the Treasury proposed changes to the SBC regulations and SBC templates that would take effect Sept. 1, 2015.
Click here for full article

February 11, 2015

Final Forms Released for Sections 6055/6056 Reporting

The IRS has released the final versions of the forms and instructions that will be used to report health coverage information to the IRS and to enrollees beginning in 2016 (for tax year 2015) under Sections 6055 and 6056 of the Internal Revenue Code. The Patient Care and Affordable Care Act requires health insurers, employers and government programs that provide minimum essential coverage to file an annual information report with the IRS indicating the individuals who were covered each month by minimum essential coverage. Additionally, large employers subject to the employer coverage mandate must report coverage information to the IRS and to all employees that were offered health coverage by the employer.
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January 26, 2015

Aetna Health Reform Weekly

In his state-of-the-union speech last week, President Obama covered a wide range of issues but did not spend much time on health care. The Republican-led Congress is trying to legislatively chip away at various provisions of the Affordable Care Act (ACA), and the U.S. Supreme Court is hearing a case that could jeopardize marketplace subsidies for more than 6 million consumers, but the President said little in response. One specific reference to health care was his announcement of a “precision medicine initiative.” The White House has indicated the initiative is meant to provide health care professionals with “tools, knowledge and treatments to tailor care to a person’s unique characteristics – such as their genetic makeup.”

Federal Republican Senators Orrin Hatch and Lamar Alexander introduced legislation last week to repeal the ACA’s individual mandate. Titled the American Liberty Restoration Act, the bill is supported by 20 other Republican co-sponsors. It is unclear if the bill will receive enough votes to overcome Democratic hurdles or if the President will veto its passage.
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January 12, 2015

Supreme Court Denies Petition for Review of Challenge to ACA's Individual Mandate

New Supreme Court Denies Petition for Review of Challenge to ACA's Individual Mandate - On January 12, 2014, the U.S. Supreme Court denied a request for review by challengers to the Affordable Care Act's individual mandate, which requires citizens to obtain health insurance or pay a tax
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January 5, 2015

Aetna - Weekly Health Care Reform Weekly

While 2014 was noteworthy for ushering in some of the most significant provisions of the Affordable Care Act (ACA), the arrival of 2015 marks the start of other notable health system changes. As of this month, employers with 100 or more workers must offer health care coverage to their employees or pay a penalty. While the employer mandate has been somewhat controversial, a recent Kaiser Family Foundation tracking poll found that 60 percent of the public favor the provision. In addition, this is the year the IRS begins collecting fines from many individuals who went uninsured in 2014. For 2014, the fine for violating the individual mandate is the greater of $95 per person or 1 percent of household income above the threshold for filing taxes. For 2015, the fine increases to the greater of $325 per person or 2 percent of income.
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December 30, 2014

Proposed Changes for the Summary of Benefits and Coverage (SBC)

On December 22, 2014, the Departments of Health and Human Services (HHS), Labor and Treasury issued proposed regulations for changes to the Summary of Benefits and Coverage (SBC). The proposed regulations clarify when and how a plan administrator or insurer must provide an SBC, shorten the SBC template, add a third cost example and revise the uniform glossary. The proposed regulations provide new information and also incorporate several FAQs that have been issued since the final SBC regulations were issued in 2012.
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December 3, 2014

Reminder: Enrollment counts for the Reinsurance Assessment Fee are due Friday

The Centers for Medicare & Medicaid Services (CMS) extended the deadline for reporting enrollment counts (not payment dates) until Dec. 5, 2014, for the Reinsurance Assessment Fee on Pay.gov.

Please note the payment date(s) have not changed. The first payment installment (or combined payment) is still due on Jan. 15, 2015, and the second payment is due Nov. 15, 2015 for those who choose to pay in two installments.

The announcement is also available on the CMS website.
Click here for full article

November 17, 2014

Deadline Extended to December 5 for 2014 Reinsurance Fee Enrollment Counts

On November 16, 2014, the Department of Health and Human Services (HHS) announced that the deadline for contributing entities to submit their 2014 enrollment counts for the transitional Reinsurance Fee has been extended. Employers sponsoring self-funded group health plans and insurers subject to the Reinsurance Fee now have until 11:59 p.m. on December 5, 2014 to upload their average covered lives data into Pay.gov and submit their ACA Transitional Reinsurance Program Annual Enrollment and Contribution Submission Form. The deadline was previously today, November 17.
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November 12, 2014

Additional Covered Preventive Care Services Effective January 1, 2015

The Patient Protection and Affordable Care Act (PPACA) mandates non-grandfathered health plans provide coverage without cost-sharing for certain in-network preventive care services for adults and children. Effective January 1, 2015, Starmark® self-funded plan designs will include 100% benefits for the preventive services listed below when they are received from an in-network provider. (Out-of-network services are subject to the plan deductible and coinsurance.) Services may vary by plan/state.
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November 10, 2014

Aetna - Weekly Health Care Reform Weekly

With Republicans taking control of the U.S. Senate in last week’s elections, experts are now predicting new efforts to repeal the Affordable Care Act (ACA) are likely to emerge in Congress. Repeal votes have been common in the House in recent years, but repeal now has a shot of passing in the Senate. Still, repeal is unlikely to make it past the President’s veto pen. Consequently, analysts predict that after repeal efforts are spent, less ambitious legislation to “fix” certain aspects of the ACA will emerge with a more realistic chance of becoming law. Republican leadership has indicated it may take on issues such as the employer mandate and the law’s definition of full-time employees. Some experts also predict that the election results now dim the prospects for expanding Medicaid eligibility in additional states next year. Twenty-seven states and the District of Columbia have expanded Medicaid eligibility so far. Medicaid expansion was originally mandated by the ACA, but a U.S. Supreme Court decision in 2012 turned the requirement into a voluntary program.
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October 2, 2014

Updated Employer Mandate Flyer Available

Final regulations addressing the Shared Responsibility requirements for employers, also known as the employer mandate, have been published.
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September 22, 2014

Aetna Health Reform Weekly

A report released last week by the Government Accountability Office (GAO) found that HealthCare.gov and its related systems continue to show weaknesses that threaten sensitive personal information if the system is breached by unauthorized users. According to the report, Healthcare.gov had weaknesses
Click here for full article

September 15, 2014

Plan Designs Now Include Benefits for Risk Reducing Medications for Breast Cancer in PPACA-Mandated Preventive Care Services Benefit for Women

Effective September 1, 2014, in accordance with the Patient Protection and Affordable Care Act (PPACA) mandate, risk reducing medications such as tamoxifen and raloxifene for women with increased risk of breast cancer will be included as part of the preventive care services benefit under Starmark® self-funded plan designs.
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August 28, 2014

State Decisions on Health Insurance Marketplaces and the Medicaid Expansion

A central goal of the Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and the Health Insurance Marketplaces. The ACA expands Medicaid coverage for most low-income adults to 138% of the federal poverty level (FPL); see this table for state by state Medicaid income eligibility levels for adults as of April 1, 2014. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion.

States' decisions about the Medicaid expansion as of August 28, 2014. States noted as “Open Debate” are based on KCMU analysis of State of the State Addresses, recent public statements made by the Governor, issuance of waiver proposals or passage of a Medicaid expansion bill in at least one chamber of the legislature. It is important to note that per CMS guidance, there is no deadline for states to implement the Medicaid expansion.
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August 11, 2014

A Health Care Reform Guide for Large Group Employers

Health care reform is changing the rules about your health plans—and some of those rules are complex. That’s why Highmark developed A Health Care Reform Guide for Large Group Employers. It is written for large groups, from 50 to 50,000 employees, whether fully insured or self-insured. As an employer, you are facing an onslaught of new regulations, responsibilities, taxes, fees and other impacts. It’s important that you have a good grasp of the basic reforms that affect your business. But understanding health care reform can be challenging. Changes, delays, new guidance and final rules abound. Our goal with this guide is to simplify health reform as much as possible, make the Affordable Care Act more understandable and describe the impacts to you in clear language. The guide is organized into nine chapters, which you can link to directly to find the topic you’re interested in. You can also browse the terms below the chapter headings and link directly to phrases like “minimum essential coverage” to learn more.
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August 4, 2014

Heatlh Care Reform Weekly - Aenta

A new General Accounting Office (GAO) report released last week found that the government did not plan well and did not properly oversee the launch of the new federal health exchange in October. The report went on to warn that the problem-plagued federal website still faces risks for the next open enrollment period unless oversight is increased and continuing back-end issues are resolved. The original contractor for the site has been replaced because of the flawed rollout, but some key federal marketplace capabilities remain unavailable. Congressional auditors noted that Healthcare.gov costs are now running close to $1 billion.
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July 30, 2014

Employer reporting: Draft forms released

On July 24, 2014, the Internal Revenue Service (IRS) released draft employer reporting forms required under the March 5, 2014, final rules implementing the information reporting requirements for insurers and certain employers under the Affordable Care Act (ACA). IRS Section 6055 requires health insurance issuers, employers, government entities and other persons that provide minimum essential coverage to file returns with the IRS and issue statements to its covered individuals that include basic identifying information about the covered individual, the months in which they were covered, and information about the plan sponsor, if applicable.
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July 25, 2014

Draft IRS Information Reporting Forms Available for Employers and Insurers

On July 24, 2014, the Internal Revenue Service (IRS) released initial drafts of forms to be used in reporting health insurance coverage offered by applicable employers, and minimum essential coverage by insurers and employers of self-insured plans. The IRS has posted the draft forms at IRS.gov/draftforms as information only, and will post final versions for actual filing at a later date. Instructions for these forms are expected to be issued later this summer. These transmittal and reporting forms were noted in the Final Rules released on March 5, 2014, which we alerted on March 7. The first reporting is required in early 2016 for the 2015 calendar year, however employers are encouraged to voluntarily report coverage information in 2015 for the 2014 calendar year.
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July 23, 2014

Two Federal Courts Rule on Subsidies

Two federal appeals courts have recently issued contradictory rulings on whether individuals enrolling in health plans offered through Marketplaces run by the federal government are eligible for subsidies to help pay for their coverage. The D.C. Circuit Court of Appeals ruled that subsidies could go only to individuals enrolled through Marketplaces established by states. The Fourth Circuit Court of Appeals (Richmond, VA) ruled that individuals enrolled through Marketplaces established by the federal government are eligible for subsidies.
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July 22, 2014

Certain PPACA Provisions Will No Longer Apply to U.S. Territories

On July 16, the Department of Health & Human Services (HHS) notified U.S. territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands) that the following Patient Protection and Affordable Care Act (PPACA) provisions will no longer apply to insured plans sitused in the territories:
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June 30, 2014

Health Care Reform Weekly - Aetna

More expert analysis has emerged forecasting a return to accelerating health care cost increases. After five years of relatively flat growth in U.S. health care costs, PricewaterhouseCoopers’ Health Research Institute is now projecting that health costs in 2015 will accelerate by 6.8 percent, up from the 6.5 percent growth rate forecast for 2014. An improving economy and shopping for health care through the Affordable Care Act’s exchanges may be contributing to the rise in costs. But other factors are holding back the acceleration from gaining even more traction, the report notes. Increasing efficiency across the industry, increased use of standardized processes, “at-risk” accountable care payment models beginning to have more impact, and major purchasers demanding greater value are all having an impact on costs.
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June 26, 2014

SHOP Employee Choice

On June 10, the Centers for Medicare and Medicaid Services (CMS) announced that the Small Business Health Options Program (SHOP) employee choice feature will not be implemented in Michigan and 17 additional states during the 2015 plan year. Employee choice is when the employer offers multiple plans to employees selecting coverage through the FF-SHOP. The employer can either offer all plans on the FF-SHOP to their employees or they can offer all plans within a metal level. Without employee choice in Michigan, the employer can only choose one plan with one issuer (at any metal level, but only one plan).
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June 16, 2014

Health Care Reform Weekly - Aetna

Health insurers last week unveiled a series of proposed solutions to help improve the consumer health care experience in the post-Affordable Care Act (ACA) era. The trade group America’s Health Insurance Plans (AHIP), of which Aetna is a member, released a package of solutions that address the need for next-step reforms enhancing affordability, stability and accessibility of health care. The proposals include allowing new, lower-premium plan options that would bring more young people into the marketplace by enhancing affordability. Individuals and family members would be eligible for premium subsidies to purchase such a plan, something that is not currently allowed. The recommendations also include enhancing stability by ensuring continuity of care protections during times of transitions in coverage, and enhancing accessibility through greater transparency.
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May 27, 2014

Aetna - Health Care Reform Weekly

Developments in the past week underscore that concerns over the rising cost of health care have not diminished despite a slowdown in cost increases during the recent recession. A new report from Milliman shows that health insurance coverage now costs $23,215 for a typical family of four with employer-based insurance. At 5.4 percent, this year’s increase in costs is the lowest in 14 years, but total costs still increased $1,100 from last year. Costs have increased 107 percent since 2004. In a related development, attention became focused last week on the skyrocketing cost of specialty pharmaceuticals because of the high price set for the drug Sovaldi, a new treatment for hepatitis C. Spending on specialty medicines, for diseases such as cancer, rheumatoid arthritis and multiple sclerosis, helped boost total spending on prescription drugs last year 3.2 percent, to $329.2 billion, according to media reports.
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May 27, 2014

Health Plan Identifier (HPID) - Trustmark

The Department of Health and Human Services (HHS) published the Final Rule on administrative data standards simplification and requirements to adopt a unique standard Health Plan Identifier (HPID) for use in HIPAA standard transactions effective Nov. 7, 2016. A new flyer is available that answers some common questions about the HPID, including what it’s used for, how to obtain a HPID, the timeline for compliance, and more.
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April 28, 2014

Aetna - Health Care Reform Weekly

Last week, experts cited in a New York Times story warned that while the Affordable Care Act (ACA) may be broadening access to health coverage as intended, getting health care costs under control is another matter. The recession may be the single biggest factor in recently slowing health care costs. Experts argue that health care costs could accelerate again as the economy improves and consumers act on pent-up demand for medical services, which may already be happening. Also, the increasing use of ever-more expensive new technologies in medicine has not changed. As a result, some predict health care will consume almost a quarter of the nation’s economic product and add further to the national debt.
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April 1, 2014

Health Plan Identifiers (HPID) - Empire BCBS

Summary Part of the Affordable Care Act (ACA or health care reform law) calls for the Department of Health and Human Services (HHS) to create a series of rules over five years that are designed to help streamline health care administrative transactions, encourage greater use of standard processes by health care providers, and make existing processes work better. In September 2012, HHS approved a national unique health plan identifier (HPID) requirement. More rules are being put in place by HHS that say health plans have to “certify” that they are following certain aspects of the Health Insurance Portability and Accountability Act (HIPAA).
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March 26, 2014

Employer Shared Responsibility requirements for 2015 and beyond – additional information on safe harbors

On Feb. 10, the final regulations for the Employer Shared Responsibility provisions (also referred to as the “employer mandate”) under the Affordable Care Act were released by the Internal Revenue Service and Department of the Treasury. These final regulations provide different types of safe harbors to employers in 2015, depending on the type of employer or plan offered. The triggers for the tax penalties also vary depending on the type and timing of the safe harbor option an employer may qualify for (and chooses to implement).
Key safe harbors for 2015 are outlined below:
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March 10, 2014

Final 2015 Notice of Benefit and Payment Parameters and Actuarial Value Calculator

On March 6, the Department of Health and Human Services (HHS) provided the 2015 actuarial value calculator and issued final regulations on the 2015 Notice of Benefit and Payment Parameters. While HHS changed a few items from the proposed rule – namely the open enrollment period and cost-sharing limits – many provisions remain the same.

Open Enrollment Period
The 2015 open enrollment period for individual and family plans has been extended by 30 days and will be held November 15, 2014 – February 15, 2015.

2015 Cost-Sharing Limits
The 2015 maximum annual out-of-pocket limits for all non-grandfathered plans will increase by 4.21 percent, lower than originally proposed. The confirmed 2015 amounts are $6,600 for individual coverage and $13,200 for family coverage. The maximum 2015 deductibles for insured non-grandfathered small group plans are $2,050 individual and $4,100 family.


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February 25, 2014

Medicaid and CHIP updates

On Jan. 22, the Centers for Medicaid and Medicare Services (CMS) released a report on the number of December applications and eligibility determinations for the Medicaid & the Children’s Health Insurance Program (CHIP). The report noted that in December 2013: 2.29 million people were deemed eligible for Medicaid and CHIP coverage by state agencies. This brings the total eligibility to 6.23 million people from Oct. 1 through Dec. 31.
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February 21, 2014

90 Day Waiting Period Final and Proposed Regulations Issued

On February 20, 2014, two regulations on the 90-Day Waiting Period Limitation were issued jointly by the Departments of Health and Human Services, Labor, and the Treasury. The first regulation is the final rule as it pertains to originally proposed regulations in August, 2013. The second is a proposed regulation that focuses on limitations to employee orientation periods.

Final Rule
There are no substantial changes from the proposed regulations in August, 2013. The waiting period limitation is the period of time that must pass before coverage for an employee or dependent, who is otherwise eligible to enroll under the terms of the plan, can become effective. This limitation can be no more than 90 days; coverage must become effective by the 91st day from the date of eligibility.


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February 3, 2014

Aetna - Health Care Reform Weekly

Despite the publicity surrounding the problem-plagued launch of new health insurance exchanges and the January 1 implementation date for many important provisions, the American public still seems largely unaware of what has changed under the Affordable Care Act (ACA). The latest Kaiser Family Foundation tracking poll found that a significant majority (62 percent) of the public continue to believe that only some of the law’s provisions are in effect. Just 19 percent say most or all of the law has been implemented.

Awareness of the individual mandate has climbed to 81 percent, but awareness of other provisions remains low – only four in 10 adults are aware of potential subsidies for coverage purchased through the new exchanges. Americans continue to have a largely negative view of the ACA overall – 50 percent have an unfavorable view of the law while 34 percent have a favorable view. But 55 percent say the focus should be on trying to improve the law rather than repeal, while 38 percent support repeal.
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January 13, 2014

Volunteer Emergency Responders Exempt

Volunteer firefighters and emergency medical providers will not be counted as full-time employees under the federal health care law, the US Department of the Treasury said in a statement January 10.
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January 13, 2014

Aetna - Health Care Reform Weekly

New research released last week by the journal Health Affairs contains some good news for employers and consumers – health care costs grew in 2012 by a modest rate for an unprecedented fourth straight year. Health spending grew 3.7 percent in 2012, slower than the rest of the economy. Health care spending actually shrank as a percentage of gross domestic product in defiance of a decade-long trend. The experts disagree on the reasons for the prolonged period of slow growth, making it hard to say just how long the trend may last. But many experts believe that spending will again accelerate when the economic recovery speeds up.

In other news, the bumpy rollout of health insurance exchanges under the Affordable Care Act (ACA) continues to cause implementation issues for states and insurers alike. But the most surprising news from last week may have been an Obama administration announcement that it is working with the state of Maryland to implement a trial program there using aggressive medical price controls to cut the growth of overall health care spending. Under the experiment (see below), Maryland will cap hospital spending and set prices
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January 10, 2014

FAQs Issued on Several PPACA Provisions

On January 9, 2014, the Departments of Health and Human Services (HHS), Labor and Treasury issued FAQs to clarify Patient Protection and Affordable Care Act (PPACA) provisions related to several topics including:

  • Preventive Services
  • Cost-sharing Requirements
  • Expatriate Health Plans
  • Wellness Programs
  • Fixed Indemnity Insurance
  • Mental Health Parity

We have summarized the information in the FAQs and provided a link to the complete FAQs below.

Preventive Services (Q1)
For women who are at increased risk for breast cancer, medications that reduce the risk of breast cancer must be covered as preventive services with no cost-sharing. This applies to non-grandfathered individual and group plans for plan years beginning on or after September 24, 2014.
Cost-sharing Requirements (Q2 – Q5)

For plan or policy years beginning in 2014, the annual limitation on out-of-pocket costs applicable to non-grandfathered plans is $6,350 for self-only coverage and $12,700 for coverage other than self-only coverage. The annual cost-sharing limit applies only to Essential Health Benefits (EHBs). Since self-insured and large group health plans are not required to cover EHBs, those plans must make a good faith effort to use an EHB definition authorized by HHS for purposes of administering the cost-sharing limitation.
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January 1, 2014

2014: The big year is finally here. Or is it?

When the Patient Protection and Affordable Care Act (PPACA) was signed into law in 2010 we expected many of the major provisions to be implemented by 2014. The opening of the Health Insurance Marketplaces was really the culmination of many sweeping changes driven by the law. While many provisions have been implemented, there have been delays the past six months for several impactful provisions. In some cases the delay reflects the Administration’s recognition that more implementation time is needed.
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December 9, 2013

Health Care Reform Weekly - Aetna

With implementation of the Affordable Care Act (ACA) riding a wave of mostly good news for a change, some were ready to declare that Obamacare had turned a corner last week. An improved Healthcare.gov website enabled the first true surge in health insurance exchange enrollments, and President Obama felt comfortable in launching a new push to promote the benefits of Obamacare. But the rollout is not out of the woods yet. Insurers warned last week that Healthcare.gov continues to generate faulty data and that the new surge in enrollments could worsen problems come January 1, 2014, when coverage actually goes into effect. In addition, it still remains unclear whether the participation of young people needed to help pay for the law’s new benefits will materialize.

One new survey released last week appeared to show that young people are quite interested in new, affordable health coverage options, while a Harvard poll found that most millennials believe Obamacare will result in higher costs and worse quality of care. The federal Department of Health and Human Services (HHS) also has announced that it is delaying the launch of the website for the federal Small Business Health Options Program (SHOP) until November 2014, a full year later than originally planned.
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November 12, 2013

Health Care Reform Today - Cigna

Three Confusing Terms: What’s the Difference? By Kathy Vaccaro, VP Health Care Reform Given the scope, reach and complexity of the Patient Protection and Affordable Care Act (PPACA), it’s understandable and not at all surprising that there’s some confusion about the terms used to describe three key PPACA provisions slated to take effect over the next 13 months. They are Essential Health Benefits, Minimum Essential Coverage, and Minimum Value. The question is, what do these terms mean and how do they differ from each other? While the terms themselves sound a bit alike, each relates to separate and distinct PPACA requirements. Let’s define the terms and briefly outline how they’ll affect individuals and employers in 2014 and 2015 – and beyond.
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November 1, 2013

A Health Care Reform Guide for Large Group employers

Health care reform is changing the rules about your health plans—and some of those rules are complex. That’s why Highmark Health Services developed a Health Care Reform Guide for Large Group Employers. It is written for large groups, from 50 to 50,000 employees, whether fully insured or self-insured.As an employer, you are facing an onslaught of new regulations, responsibilities, taxes, fees and other impacts. It’s important that you have a good grasp of the basic reforms that affect your business. But understanding health care reform can be challenging. Changes, delays, new guidance and final rules abound. Our goal with this guide is to simplify health reform as much as possible, make the Affordable Care Act more understandable and describe the impacts to you in clear language.

The guide is organized into nine chapters, which you can link to directly to find the topic you’re interested in. You can also browse the terms below the chapter headings and link directly to phrases like “minimum essential coverage” to learn more
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October 28, 2013

Health Care Reform Weekly

With Congress now focused on dissecting the troubled rollout of health insurance exchanges, the Obama administration is making modifications to its marketplace schedule and is facing pressure to do more. The administration announced last week that it will issue new guidance pushing back the date by which individuals must have health care coverage or face a penalty. The new date, March 31, 2014, coincides with the end date for the open enrollment sign-up period. Late last week, 10 Senate Democrats signed on to a letter calling on the administration to extend the open enrollment period, by an unspecified period, as well. Another Democratic Senator, Joe Manchin of West Virginia, is urging a one-year delay in the mandate. Meanwhile, experts called in to fix the website are predicting an end to the majority of problems by late November. Even if the projection is accurate, many fear enrollment in exchanges will suffer as a result of the significant rollout issues.
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October 7, 2013

Heatlh Insurance Exchanges

The Affordable Care Act (ACA) created guidelines for a new kind of marketplace for health insurance. Learn more about exchanges and how Aetna supports them.

Exchanges at a Glance. What are exchanges?
Exchanges (also called "marketplaces") are online markets where consumers and small businesses can go to shop for health insurance. On these sites, they can compare the available plans and then purchase online.
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October 1, 2013

Health Care Reform Subsidy Calculators - KFF.org

This tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). Beginning in October 2013, middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies available through state-based exchanges.
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September 30, 2013

Aetna - Health Care Reform Weekly

A report released by the Department of Health and Human Services (HHS) this week finds that consumers will see lower than projected premiums in the Health Insurance Marketplaces set to go live on October 1st. According to the report, consumers will be able to choose from an average of 53 health plans in the Marketplace. The majority of consumers will have a choice of at least two different health insurance companies – although some consumers will only have one option available for 2014. Premiums nationwide will also be around 16 percent lower than originally projected – with about 95 percent of eligible uninsured live in states with lower than expected premiums – before taking into account financial assistance.
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September 3, 2013

Aetna Health Care Reform Weekly

A study published in the Journal of American Medicine shows that programs designed to improve quality and reduce costs, such as Accountable Care Organizations (ACO), can also lower costs for patients outside the program who see the same providers. An ACO is a network of doctors and hospitals that shares responsibility for providing care to a specific group of patients. There are already more than 428 ACOs in the U.S., serving an estimated 14 percent of the population, including both Medicare and private-insurance patients. Many ACO agreements only a cover a portion of the patients in a health care network, which means the rest of the patients served by those providers are in a traditional fee-for-service model. However, researchers at the Harvard Medical School say there appears to be a “spillover savings” for all patients in the network – savings were significant, in excess of 3 percent, according to the study.
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September 3, 2013

Employer Deadline to Notify Employees About Health Coverage Options Nears

Regardless of government delays on the employer mandate and income reporting parts of the health care reform law, October 1, 2013 is still a firm deadline to notify employees about the option they have to enroll in a Marketplace health plan. In preparation for the opening of the Health Insurance Marketplace in January, 2014, employers — those with under 50 and over 50 employees — must notify employees of open enrollment options under the Affordable Care Act (“Obamacare”) by October 1, 2013. Under the ACA, employers are required to notify their employees that health insurance options are available on the public Health Insurance Marketplace, or Exchange. Employers must also inform employees up-front about possible tax credits to help pay for health insurance should any employee choose to buy a qualified Marketplace Health Plan. In such cases, there will be implications for an employer when an employee chooses Marketplace coverage. This required notice to employees applies to employers whether or not they currently offer health care coverage.
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August 28, 2013

IRS Issues Final Rule on the Individual Mandate

On August 27, the Internal Revenue Service (IRS) issued a final rule for the individual mandate provision of the Patient Protection and Affordable Care Act (PPACA). As a reminder, the individual mandate requires most individuals to have minimum essential coverage in 2014 or pay a penalty. The penalty is called a shared responsibility payment. Some individuals may qualify for an exemption from the mandate so they will not be required to have coverage or pay a penalty. An individual seeking an exemption may do so in advance through an application submitted to the Exchange/Marketplace or after the fact with the IRS through the tax filing process. An applicant can apply for multiple exemptions simultaneously. The final rule, which is largely consistent with the proposed regulations, confirms the following:
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August 13, 2013

Employer Responsibility with Exchange Notices

The Patient Protection and Affordable Care Act (PPACA) requires employers subject to the Fair Labor Standards Act (FLSA) to provide all employees, regardless of full- or part-time status, a notice regarding public health insurance exchanges beginning no later than Oct. 1, 2013. Federal agencies have issued model notices for employers to use: one for employers who sponsor a health plan and another for employers who do not sponsor a health plan. Both notices, which are available in English and Spanish, can be found on the U.S. Department of Labor website.
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July 31, 2013

Patient-Centered Outcomes Research Fund Fee Q&A

Under Section 6301 of the Affordable Care Act (ACA), health insurance issuers and sponsors of self-funded group health plans will be assessed an annual fee to fund patient-centered outcomes research. The fee is imposed for a limited number of years, beginning in 2012 and ending in 2019.

What is the Patient-Centered Outcomes Research Trust Institute?
The Patient-Centered Outcomes Research Institute (PCORI) is a nonprofit corporation that has a 21-member Board of Governors. Duties of the PCORI include identifying research priorities and establishing and carrying out a research project agenda. The PCORI’s mission is to help people make informed health care decisions and improve health care delivery and outcomes, by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers and the broader health care community.
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July 29, 2013

Aetna - Health Care Reform Weekly

President Obama is moving forward with plans to sell the benefits of the Affordable Care Act (ACA) to young Americans with the help of celebrities and his wife, Michelle. But it may be tough to establish momentum, given recent hurdles for implementation of the law. Republican members of the House are calling for steep budget cuts and cuts to ACA funding if they are to agree to any plan to raise the nation’s debt ceiling. And, a new poll released last week shows that a group of once loyal Democrats is turning against the health reform law. A new Washington Post-ABC News poll found that support for the ACA among moderate and conservative Democrats has fallen from 74 percent in 2010 to just 46 percent today. It remains to be seen whether shrinking Democratic support will have any practical impact in the House or Senate, but the trend is not making it any easier to sell the law to the public.
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July 3, 2013

Employer Responsibility and Information Reporting Requirements Delayed Until 2015

On July 9, 2013, the IRS issued a notice confirming the delay of the employer shared responsibility penalty and information reporting requirements until 2015. The notice affirmed the details below.

On July 2, 2013, the Treasury Department announced that enforcement of the employer shared responsibility payments of the Patient Protection and Affordable Care Act (PPACA) will be delayed by one year, until 2015. Compliance with the law’s information reporting provisions will be voluntary for 2014, but strongly encouraged. Formal guidance is expected within the next week.

The Administration said they recognized the information reporting required by insurers, self-insured employers and others providing health coverage is complex so they will try to streamline the requirements over the next few months through discussions with stakeholders. Proposed rules on the reporting requirements are expected to be issued this summer. Without the reporting requirements in place, it would be “impractical to determine which employers owe shared responsibility payments,” according to the post on the Treasury Department’s website.
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June 26, 2013

The Affordable Care Act: A Summary of Fees and Taxes

The Affordable Care Act: A Summary of Fees and Taxes The Affordable Care Act (ACA) imposes a range of new fees and taxes on health insurance issuers (e.g., Coventry health plans) and sponsors of group health plans (e.g., employers). These fees and taxes are meant to offset some of the costs incurred by the federal government.
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June 25, 2013

New rules modify wellness plans

The federal government has issued final regulations for wellness programs under the HIPAA Nondiscrimination Rules. These apply to insured and self-funded group health plans. Plans that are grandfathered under the Affordable Care Act must also adhere to these rules, which are effective for plans effective on or after January 1, 2014.
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June 3, 2013

Wellness Programs and Rewards Final Regulations Released

Final regulations on wellness programs and rewards for group health plans were issued on May 29, 2013 by the Departments of Treasury, Labor and Health and Human Services. These regulations apply to insured and self-insured group plans, both grandfathered and non-grandfathered, for plan years beginning on or after January 1, 2014.

The final regulations confirmed the maximum wellness reward amounts that will be allowed.
The maximum wellness program reward is 30 percent of the total cost of medical coverage, including both employer and employee contributions.
The maximum wellness program total reward may be increased to 50 percent for programs related to tobacco use.
Rewards can take many forms, such as premium discounts or surcharges, reduced cost sharing, enhanced benefits, gift cards or deposits to Health Savings Accounts or Health Reimbursement Accounts.
The reward must be available at least once per year for all similarly situated individuals.
The family members participate in wellness programs, the reward can be based on the total cost of coverage for all covered family members. If some family members are eligible for the reward and others are not, employers have flexibility in determining the portion of the reward attributable to each family member.
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May 29, 2013

Health Care Reform: What is a health insurance exchange?

In case you haven’t heard, big changes are coming in October 2013. Big changes for a lot of people.

The Affordable Care Act is expected to help increase access to health care. Health insurance exchanges will be an important part of that.

Most people get health insurance through their employers. But people without this option will now be able to shop for health insurance on exchanges, as an alternative to buying coverage directly from individual health insurers. Exchanges are new and easy to use. And they’ll be open for business in October 2013, allowing consumers to shop for health plans that will begin on January 1st.

Experts predict that by 2016, more than 25 million people will use exchanges to buy health insurance.
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May 21, 2013

Marketplace notification must be issued by Oct. 1

Beginning in 2014, Americans will be able to purchase health benefits from the Health Insurance Marketplace. The Affordable Care Act requires employers to notify their employees of the existence of the Health Insurance Marketplace. On May 8, the Department of Labor provided guidance on fulfillment of this requirement.

To satisfy the requirement, employers must:

  • Provide notification to current employees no later than Oct. 1, 2013.
  • Provide notification to newly hired employees upon hiring on and after Oct. 1, 2013. Beginning in 2014, new employers must be notified within 14 days of the employee's start date.
  • Provide the notification at no cost to the employee.
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May 20, 2013

Aetna Health Care Reform

The Congressional Budget Office (CBO) released an updated budget report last week that projects health care costs will slow further and the deficit will fall faster over the next 10 years than previously projected. For the next 10 years, the CBO projects a cumulative deficit of $6.34 trillion, which is $618 billion less than it projected in February. The expected reduction is due mostly to lower projections of spending for Social Security, Medicare, Medicaid, and interest on the public debt. With respect to the Affordable Care Act (ACA), the CBO projects that subsidies provided in the form of tax credits for consumers who buy coverage through the exchanges will be $138 billion lower over 10 years, compared to previous projections. One of the primary drivers of the lower estimates is a projection that more people will obtain coverage through Medicaid and fewer through the exchanges.
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May 1, 2013

The Road to Reform: Preparing for health reform in 2013 - 2014

UnitedHealthcare recognizes that our American health system requires fundamental change to provide affordable, quality care. Health reform is a start but more is needed to address health care costs that are rising continually and a system where care is too variable. Innovative, value-oriented and outcome-focused approaches can help make the system work better for everyone.

At UnitedHealthcare, our goal is helping people live healthier lives.TM Through the use of best practices, UnitedHealthcare is working to build a better, more affordable health care system. We help make this happen by:

  • Providing innovative and affordable choices in the health plans we offer
  • Modernizing delivery of health care by development of tools and programs to make health care easier to understand and navigate
  • Focusing on quality of service and simplicity of administration
  • Informing and engaging your employees regarding their health to help them make healthier choices

The Affordable Care Act (ACA) brings significant changes to how Americans access and pay for health care. And while change is good, it can be challenging. We want to help you understand health reform and let you know that you are not in this alone. We’re with you every step of the way. We are taking steps to ensure that UnitedHealthcare’s plan designs conform to the ACA’s mandates.
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April 30, 2013

Point of View PPACA by Assurant Employee Benefits

Clarification to Recent News Articles
"Health Insurance Exchange for Small Businesses to be Delayed"
"Sebelius: Insurer Feedback delays SHOP exchange"
"Feds delay small-business health care program"
Many of you have probably seen the headlines, but they are very misleading. The truth is that only one feature of the SHOP exchanges has been delayed: employee-choice requirements.

What Does This Mean?
In 2014, the Federally-Facilitated SHOP exchanges will be operational, but will not offer employee-choice for benefits. The employer will make the choice and offer only one carrier to their employees. In 2015, the SHOP exchanges will begin offering employee-choice.

This applies to the Federally Facilitated Exchanges (FFE) only, state-based exchanges might allow employee-choice.
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March 25, 2013

Health Reform Weekly

Implementation of the most significant provisions of the Affordable Care Act (ACA) is less than a year away, but Americans remain a bit puzzled by it all. A new Kaiser Family Foundation tracking poll shows that two-thirds of the uninsured and a majority of the general public are struggling to understand how the law will impact them. In fact, awareness of the law’s key elements has declined somewhat since passage of the law in 2010, when media attention was at its height.

The survey also found that the public is not really tuned in to the biggest ACA implementation issues going on right now, such as state decisions on whether to implement state-based exchanges and whether to expand Medicaid coverage. In general, the country remains divided on the merits of the law, with 40 percent having an unfavorable view and 37 percent holding a favorable one.

The Senate and House last week passed a Continuing Resolution to fund the government for the remainder of the fiscal year through September 30, 2013. The package includes appropriations bills for Defense; military construction and Veterans Affairs; Agriculture; Commerce, Justice and Science; and Homeland Security that reallocate funds for select programs to mitigate the impact of the sequester cuts. The bill does not include the $949 billion in increased funding to implement the ACA that the Obama Administration had requested. Nonetheless, President Obama is expected to sign the legislation when he returns from the Middle East.
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March 19, 2013

Most PPACA Provisions for Expatriate Plans Delayed Until 2015

On March 8, 2013, the Departments of Labor, Health and Human Services and Treasury issued a Frequently Asked Question (FAQ) announcing that compliance with most Patient Protection and Affordable Care Act (PPACA) provisions is being delayed for expatriate plans meeting this definition: Insured group health plans with plan years ending on or before December 31, 2015, in which enrollment is limited to individuals residing outside of their home country for at least six months of the plan year and any covered dependents.

This delay impacts most PPACA provisions, including the prohibition on discrimination in favor of highly compensated individuals, the Summary of Benefits and Coverage, and guaranteed renewal of expatriate coverage even when an individual is no longer an expatriate. The Departments noted above implemented this delay to allow time to gather further information and analyze the unique challenges identified by the industry that PPACA presents to these expatriate plans. Additional clarifications, per the expatriate plan definition above, included: Expatriate coverage is exempt from the Reinsurance Assessment during this delay period.

IMPORTANT: This is a change since our March 8 news alert about the Reinsurance Assessment, which reflected our understanding at the time. All federal requirements that were in place before PPACA became law, including Mental Health Parity, the Health Insurance Portability and Accountability Act (HIPAA) and ERISA, will continue to apply to expatriate plans. Expatriate coverage will qualify as minimum essential coverage for purposes of the individual mandate. Participants will not be subject to penalties during the delay period.
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March 4, 2013

Health Insurance Exchanges - Aetna HCR Weekly

The Affordable Care Act (ACA) created guidelines for a new kind of marketplace for health insurance. Learn more about Exchanges and how Aetna supports them.

Exchanges at a Glance
What are exchanges?
Exchanges are online marketplaces where consumers can go to shop for health insurance. On these sites, consumers can compare the plans available to them and then purchase online.

Who creates and maintains the exchanges?
Each state has the option to create and operate its own exchange. If the state opts not to offer an exchange, a federal exchange will be available. Outside of the government, private exchanges may also exist.
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March 4, 2013

Health Reform Weekly

An analysis released last week by the consulting firm Oliver Wyman forecasts higher premiums, reduced benefits and a possible loss of coverage options for seniors enrolled in Medicare Advantage plans if proposed payment cuts are enacted. The analysis estimates that new payment cuts proposed by the Centers for Medicare and Medicaid Services (CMS) combined with payment cuts and taxes under the Affordable Care Act (ACA) will result in benefit cuts and premium increases averaging $50 to $90 per month for a typical Medicare Advantage beneficiary starting next year. The report goes on to say that the proposed changes could result in significant upheaval in the Medicare Advantage market, including potential plan exits from some local markets. In addition, if the automatic cuts known as “sequestration” are not averted, the Medicare program’s physician and hospital reimbursement rates will be reduced by an additional 2 percent.
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February 27, 2013

EHB Final Rule, Calculators and FAQs on Preventive Care and Cost Sharing

On February 20, 2013, the Department of Health and Human Services (HHS) issued its final rules on Standards Related to Essential Health Benefits (EHB), Actuarial Value and Accreditation. It also provided additional guidance in the form of Frequently Asked Questions.
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February 20, 2013

Essential Health Benefits issued by HHS on February 20

Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation
AGENCY: Department of Health and Human Services
ACTION: Final rule
SUMMARY:
This final rule sets forth standards for health insurance issuers consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Specifically, this final rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value. This rule also finalizes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans.
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February 7, 2013

IRS and HHS Issue Proposed Regulations on Individual Man

On January 30, 2013, the Internal Revenue Service (IRS) and the Department of Health and Human Services (HHS) issued two sets of proposed regulations related to the individual mandate provision of the Patient Protection and Affordable Care Act (PPACA). The individual mandate requires most individuals to have minimum essential coverage or pay a penalty beginning in 2014. The penalty is now called a “shared responsibility payment.” Some individuals may qualify for an exemption so they will not be required to have coverage or pay a penalty.
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January 28, 2013

Aetna Health Reform Weekly

A coalition of business groups, health plans and pharmaceutical companies is calling on the Department of Health and Human Services (HHS) to trim the essential health benefits (EHB) that qualified plans must provide to meet the requirements of the Affordable Care Act (ACA). A final EHB rule is expected from HHS in the next couple of months and many are concerned the minimum level of benefits required will be richer than many health plans sold today, making coverage unaffordable for many individuals and small employers.
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January 25, 2013

The federal government has delayed the exchange notification requirement

The Affordable Care Act requires employers to notify their employees of the existence of health benefits exchanges. The original act required the notification be issued by March 1, 2013. Information released on Thursday postpones the requirement likely until late summer or fall 2013. The goal is to coincide with open enrollment on the Exchanges, which begins Oct. 1, 2013 (for a Jan. 1, 2014 effective date.)
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BSI Corporate Benefits partners with a number of industry professionals to stay current on the Patient Protection and Affordable Care Act provisions and updates. These include Tax Advisors, CPAs, Health Care Reform Analysts and Business Advisors. Most importantly, BSI retains professional legal counsel that specializes in Health Care Reform Compliance for all client needs and company specific action plans.

Industry Professionals - Health Care Reform News:

October 13, 2015

PATIENT CENTERED OUTCOMES RESEARCH FEE (PCOR FEE): UPDATED FEE SCHEDULE RELEASED

Fees imposed on certain health insurers and plan sponsors of certain self-insured health plans, known as the Patient Centered Outcomes Research Fee (PCOR Fee or PCORI Fee), are due on July 31. The fees are a requirement under Health Care Reform to help finance the Patient-Centered Outcomes Research Institute (the “Institute”) . The Institute is a private, nonprofit corporation established under Health Care Reform to fund research of the clinical effectiveness of medical treatments, procedures, drugs, and other strategies or items that treat, manage, diagnose, or prevent illness or injury.
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October 1, 2015

Benefit Trends to Watch in 2016—and Beyond Employers are challenged to control health costs while providing more personalized benefits

n 2016, more employers will introduce consumer-driven health plans, putting the onus for saving money onto employees. Part of that savings may stem from innovations such as visiting doctors virtually—via video, over their computer. To hang on to top talent, HR practitioners also will roll out new, creative and customized voluntary benefits. Student loan assistance, anyone? And benefits professionals will have to communicate—effectively—with employees and the C-suite about all these offerings and changes. Here’s how benefit experts tell SHRM Online they plan to do it.
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September 25, 2015

30% of carriers filed PPACA fee forms late

he Internal Revenue Service had a hard time getting health insurers to submit their 2014 health insurance provider fee forms on time. Section 9010 of the Patient Protection and Affordable Care Act requires health insurance companies, health maintenance organizations and other "covered entities" to pay a total of $8 billion in health insurer fees for 2014 to help compensate for the cost of PPACA programs. The total Section 9010 insurer fee amount is supposed to rise to $11.3 billion for 2015, hold at $11.3 billion for 2016, and then rise to $13.9 billion for 2017.
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September 22, 2015

Smaller Hikes in Health Premium Rates Forecast for 2016

Compared to the steep spikes in health plan premiums seen in years past, rate increases for 2016 will remain relatively modest for most medical plan options, although still outpacing overall inflation as represented by the consumer price index (CPI). But costs will increase substantially for prescription drug coverage, hitting double-digit rates, according to forecasts based on recent health cost trend surveys. The 2016 Segal Health Plan Cost Trend Surveyreport, released in September 2015, captured data on cost projections for large U.S. group health plan sponsors before any plan design changes have been made. The survey examined 2016 projected medical cost trends as reported by major health insurance firms by service type.
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September 18, 2015

PPACA state exchanges have work to do

The federal government still has a lot of work to do to improve the performance of the 14 state-run health insurance exchanges that were set up as part of the Patient Protection and Affordable Care Act. In a report, the Government Accountability Office outlines a number of IT weaknesses that continue to prevent the system from meeting full expectations. However, much of the information upon which the report is based is not up-to-date. The audit reports, for instance, that as of November 2014, 7 of 37 states using the federally-run insurance marketplace were either not able to transfer health insurance applications between the state-run Medicaid system and a key component of the federal marketplace or had not tested their systems to see if they could do it.
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September 1, 2015

5 changes to the health care landscape

Health plan premiums continue to rise and employers are concerned with the approaching Cadillac tax. The following data from the Kaiser Family Foundation/Health Research & Educational Trust 2015 Employer Health Benefits Survey sheds some light on just how much employers and employees are paying for health care.
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August 23, 2015

'Striking change' in employer-sponsored health care premiums

The days of double-digit health insurance premium increases seem to be behind us, according to a study released today by the Kaiser Family Foundation and the Health Research & Educational Trust. Two major trends are continuing: a slower rate of premium increases and a greater use of high-deductible health plans, especially among small employers, the study found. Specifically, average annual premiums for employer-sponsored family coverage increased 3% from last year.

“That’s a pretty striking change” from the early 2000s, when premium increases soared into double digits, Drew Altman, CEO of the Kaiser Family Foundation, observed. “You can see the direction, and it’s pretty remarkable. The picture is one of long-term moderation and stability in the group market of employer health insurance coverage, including since the passage of the Affordable Care Act.”
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August 13, 2015

How the gay marriage ruling impacts group benefits

The Supreme Court’s early summer ruling in Obergefell v. Hodges affects more than just same-sex couples seeking equal marriage rights — it also impacts employers and the benefits they offer. As open enrollment season approaches, advisers would be wise to help their employer clients take a close look at plan offerings.
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August 7, 2015

IRS RELEASES 2015 DRAFT INSTRUCTIONS AND UPDATED DRAFT FORMS FOR ACA EMPLOYER REPORTING

The IRS has released 2015 draft instructions for Forms 1094-B, 1095B, 1094-C and 1095-C and updated draft forms for 1095-B and 1095-C. While these draft instructions and forms can be helpful in assisting employers and producers in their ongoing preparation for the upcoming 2015 ACA employer reporting (filed in early 2016), it is also important to note these are still draft instructions and forms. This means there still could be additional drafts released before the instructions are finalized. In other words, employers could still additional changes to the forms and instructions prior to filing.
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August 5, 2015

Why did health spending rebound?

It was nice while it lasted, but it’s over and may not return for many years, if ever. The “it” is the slowdown in national health spending. From 2008 to 2013, health spending grew roughly 4 percent a year, which was less than half the 9 percent average of the three decades before the Great Recession. Because the 4 percent rate matched the economy’s overall growth, health spending stabilized at 17.4 percent of gross domestic product (GDP). There was some hope that an era of sizable increases was over.
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August 1, 2015

Supreme Court upholds subsidies

Washington, District of Columbia, U.S. - Supporters at the U.S. Supreme Court rally in support of Obamacare. The court ruled 6-3 in King vs Burwell that language in the law was constitutional. Obamacare has been saved yet again by the Supreme Court. The Supreme Court ruled 6-3 June 25 that the subsidies under the Patient Protection and Affordable Care Act will stay.
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July 13, 2015

Why data is the next big thing in plan design

By using data to understand health plan supply, advisers can help their employer clients engage better provider choices for their employees. Supply side design is still being developed as the data becomes more sophisticated and also as employers continue to grapple with the requirements of the Affordable Care Act’s excise tax, which kicks in in 2018.
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July 9, 2015

PPACA calorie rule delayed

In yet another major Obamacare deadline setback, restaurant owners won’t have to inform patrons of the number of calories in their fare. The calorie requirement, included in the Patient Protection and Affordable Care Act, had restaurant owners and major grocers up in arms due to uncertainties about reporting and the cost of compliance.
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June 18, 2015

What if the Supreme Court rules on the PPACA case for King? 5 problems with eliminating Obamacare subsidies

As those in the know about King v. Burwell anxiously await the U.S. Supreme Court’s verdict in the PPACA insurance premium subsidy case, the Robert Wood Johnson Foundation and the Urban Institute have teamed up for one more worst-case scenario report. Assuming that the court strikes down the subsidies, RWJ and the institute produced one last “what-if” forecast. This one looks at the collateral damage that subsidy elimination could cause apart from simply pulling coverage out from under the 6.4 million whose premiums would disappear. Here are its projections:
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June 15, 2015

3 FAQs about IRS PPACA reporting requirements

The IRS has stepped in once again to clear up the confusion around another set of requirements of the Patient Protection and Affordable Care Act. This time, the confusion involves PPACA reporting requirements set to kick in next year for applicable large employers, or ALEs. And you might want a pint of the suds to help wade through the guidance. Essentially, what's being explained is how employers are to report the health insurance coverage status of employees.
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June 10, 2015

Health Plans Must Pay PCORI Fees by July 31

The federal Patient-Centered Outcomes Research Institute (PCORI) is tasked with evaluating and comparing health outcomes and clinical effectiveness, risks and benefits of medical treatments, services, procedures and drugs. Under the Affordable Care Act (ACA), health insurers and plan sponsors of self-insured group health plans are responsible for paying an annual fee by July 31 to fund PCORI. The fee applies to plan years (and policy years) ending after Sept. 30, 2012, and before Oct. 1, 2019, and is based on the average number of lives covered under the plan. 2015 PCORI Fee Amount For self-insured plans, the fee is due no later than July 31 of the year following the last day of the plan year and will vary depending on when the plan year ends.
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June 1, 2015

REMINDER - PATIENT CENTERED OUTCOMES RESEARCH FEE (PCOR FEE): FILING & PAYMENT DEADLINE IS JULY 31, 2015

Fees imposed on certain health insurers and plan sponsors of certain self-insured health plans, known as the Patient Centered Outcomes Research Fee (PCOR Fee or PCORI Fee), are due on July 31, 2015. The fee is a requirement under Health Care Reform to help finance the Patient-Centered Outcomes Research Institute (the “Institute”)1. The Institute is a private, nonprofit corporation established under Health Care Reform to fund research of the clinical effectiveness of medical treatments, procedures, drugs, and other strategies or items that treat, manage, diagnose, or prevent illness or injury.
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May 25, 2015

Four Words That Imperil Health Care Law Were All a Mistake, Writers Now Say

WASHINGTON — They are only four words in a 900-page law: “established by the state.” But it is in the ambiguity of those four words in the Affordable Care Act that opponents found a path to challenge the law, all the way to the Supreme Court. How those words became the most contentious part of President Obama’s signature domestic accomplishment has been a mystery. Who wrote them, and why? Were they really intended, as the plaintiffs in King v. Burwell claim, to make the tax subsidies in the law available only in states that established their own health insurance marketplaces, and not in the three dozen states with federal exchanges?
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May 21, 2015

3 possible outcomes for the Cadillac tax and how to prepare for them

There are three options of what might happen to the Affordable Care Act's "Cadillac tax" before it begins to take effect in 2018. No matter which one prevails, there are steps to take now in preparation. The 40% nondeductible excise tax on employer-sponsored “high cost health coverage” is technically assessed to insurers and plan administrators, but they will pass in onto the consumer, said Roger Abramson, general counsel at Ameriflex, a third-party benefits administrator.
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May 11, 2015

'Striking change' in employer-sponsored health care premiums

The days of double-digit health insurance premium increases seem to be behind us, according to a study released today by the Kaiser Family Foundation and the Health Research & Educational Trust.
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April 22, 2015

House and Senate budget talks target Affordable Care Act

On Monday afternoon, House and Senate members gathered on Capitol Hill to hash out their differences on a budget blueprint for the next decade. But there was little debate over specific discrepancies between the House and Senate plans. Instead, the two-hour hearing was devoted to speeches by conference committee members rehashing familiar partisan tropes. “Repealing the president's healthcare law would pave the way to starting over on patient-centered healthcare reform, where patients and families and doctors are making medical decisions, not Washington, D.C.,” said Rep. Tom Price (R-Ga.), chair of the House Budget Committee.
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March 25, 2015

White House Kicks Off Health Care Reimbursement Project

The cost of health care is increasing at a lower rate than it has in the past. Though President Barack Obama’s administration has said the Affordable Care Act, the health care reform law, is responsible for the slowdown, economists say it’s too soon to tell what the law’s effects on cost have been, and are crediting the change mostly to the Great Recession. But now the 5-year-old Affordable Care Act is slated to take on a more-active role on how much the country spends on health care. The law’s aim is not only to get more people access to health care, but to make people healthier – and to do so in a less-expensive way.
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March 24, 2015

Health Care Reform - 2015 Update SHRM

These survey findings examine the impact of the Patient Protection and Affordable Care Act (ACA), legislation passed by the U.S. Congress in 2010, on organizations. Starting on January 1, 2015, the employer mandate became effective for organizations with 100 or more full-time equivalent employees working an average of at least 30 hours per week (including the sum of hours by part-time employees that added together equal “equivalent” full-time employees). Under the ACA, these employers must offer full-time employees and their dependents affordable health care coverage or be subject to penalties. Small businesses with 50 to 99 FTEs will need to start insuring full-time employees by January 1, 2016.
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February 19, 2015

IRS tweaks some PPACA employer penalty rules

The Internal Revenue Service has come up with a collection of employer mandate penalty patches. The patches, described in IRS Notice 2015-17, could help employers that have been using employer payment plans to pay for employees' health coverage. The patches could also help S corporations that are paying for coverage for 2 percent shareholder-employees, and a related interpretation could help employers that are increasing workers' pay to help them pay for individual health coverage.
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February 10, 2015

IRS Issues Forms and Instructions for ACA Reporting

An earlier version of this article was first posted in July 2014 after draft versions of the reporting forms were issued by the IRS. The article was updated on 2/10/2015 to reflect the issuance of final versions of these forms and instructions, and subsequently revised on 2/17/2015. In early February 2015, the IRS released final versions of the forms that employers subject to the Affordable Care Act (ACA) “shared responsiblity” mandate—sometimes referred to as “play or pay”—will be required to file in order to show that the health coverage they offer to their employees is compliant with ACA requirements. The forms implement reporting obligations under Internal Revenue Code sections 6055 and 6066, which the ACA added to the tax code. The forms are not required to be filed by employers for tax year 2014. However, in preparation for the first required filing of these forms (in 2016 for 2015), reporting entities may, if they wish, voluntarily file. The IRS also released a new brochure Affordable Care Act: Reporting Requirements for Applicable Large Employers, which discusses getting ready for monthly tracking and preparing to fill out new IRS forms in 2016. The final forms include:
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January 30, 2015

Consumerism, Cost-Shifting Helped Restrain Health Spending

HR professionals indicated that offering consumer-directed health plans was among the most successful strategies for controlling the costs of health care, along with increasing the employee share of total costs and offering a variety of preferred provider organization (PPO) plans. These were among the key findings of the Society for Human Resource Management (SHRM) Strategic Benefits?ealth Care survey report, posted online in January 2015. The survey was fielded in April-May 2014 to randomly selected SHRM members. Health care costs were defined as employer-paid premiums, administration costs and any individual medical claims covered by the employer. Most employers in the U.S. continue to see their health care costs rising year after year, putting pressure on HR to continue to look for cost-savings. Over the last three years, more than two-thirds of respondents indicated their organization? total health care costs increased compared with the previous plan year, the survey found.
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January 28, 2015

IRS summarizes PPACA mandate rules

This year, most individuals and families should be able to cope with Patient Protection and Affordable Care Act tax reporting requirements by checking the "full-year coverage" box on line 11 of Form 1040-EZ, line 38 of Form 1040A or line 61 of Form 1040. Taxpayers who cannot check that box will have some extra tax return work to do. Gladys Nichols, an official at the Internal Revenue Service, talks about the PPACA "individual shared responsibility" and advance premium tax credit tax filing requirements in a guide aimed at agents, brokers and other public exchange helpers. The guide, posted on a Centers for Medicare & Medicaid Services website, provides a rundown of the forms individuals should be getting for the current tax filing season and the forms those people will have to file with the IRS.
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January 9, 2015

Employers applaud employer mandate bill

The Republican-led House of Representatives didn’t waste any time smashing a symbolic hole in the Patient Protection and Affordable Care Act. This week, the House approved a bill that would redefine a full work week for purposes of triggering a requirement of PPACA. When the law originally took effect, it defined the full work week for purposes of health coverage as 30 hours. It was among the most contentious elements of the law, and led to the creation of “More Time for Full Time,” an organization of organizations opposed to it.
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December 9, 2014

The top news stories of 2014: ACA law and best practices

This year saw not only more implementations of President Barack Obama’s signature health care law, but already some changes to it – by both the legislative and judicial arms of government. Additionally, new technologies and outlooks are changing how benefit decision-makers are strategizing wellness programs. Take a look back and make sure your own policies are up to date, based on EBN’s analysis from throughout the year.
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December 8, 2014

Health care benefits in 2015: What employers need to know

As health care reform continues to unfold, employers are re-examining the role of their benefit programs in their overall human capital strategy and coming around to the idea that attracting, retaining and engaging workers hinges on the total employee experience, not health care benefits alone.
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August 8, 2014

New rates for 'affordable coverage' under ACA announced

Under the terms of the Affordable Care Act, large employers are required to provide affordable coverage beginning in 2015 or potentially face penalties. For 2014, the definition of affordability was set at 9.5% of the employee’s income. Within the definition of affordability, there is also a provision that provides for adjustment of that figure in the future, and the IRS has issued its first adjustment for the 2015 plan year. For plan year beginning in 2015, Rev. Proc. 2014-37 sets the new limit at 9.56% of employee income. Revenue Procedure 2014-37 also adjusts the affordability percentage for the exemption from the individual mandate for individuals who lack access to affordable minimum essential coverage. For plan years beginning in 2015, coverage is unaffordable for purposes of the individual mandate if it exceeds 8.05% of household income (as
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July 29, 2014

IRS Issues Draft Forms for 2015 ACA Reporting

On July 24, 2014, the Internal Revenue Service released drafts of the forms that large employers will be required to file in order to show that the health coverage they offer to their employees complies with the Affordable Care Act (ACA) “shared responsibility” mandate, sometimes referred to as “play or pay.” On the same day, an administration official told Politico that the White House has no plans to further delay the ACA’s employer mandate timeline announced earlier this year. Companies with 100 or more full-time equivalent employees must begin complying with the ACA coverage requirements in 2015, although they will have two years to phase up to the requirement that they cover 95 percent of their workers. Companies with 50 to 99 full-time equivalent employees will have another year—until 2016—to start complying. Smaller businesses are exempt. - See more at: http://www.shrm.org/hrdisciplines/benefits/articles/pages/aca-reporting-draft-forms.aspx#sthash.52bwwd54.dpuf
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July 23, 2014

PPACA extends dental coverage to more young people

Almost by chance, the Patient Protection and Affordable Care Act has led to more young people enjoying dental insurance. This was among the nuggets mined from research conducted by three members of the American Dental Association Health Policy Institute. They examined two years of health coverage data focusing on dental benefits coverage, dental care utilization, and financial barriers to dental care.
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July 14, 2014

After last year's early renewal, now what to do?

Not long after the summer memories of the beach and vacations fade, your insurance agent/broker will be calling to set up a meeting to review your company's 2015 health insurance options. If you are suffering from a health care reform hangover you are not alone. Companies must continue to deal with the ramifications of reform far into the future as various provisions take effect over the next several years.
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June 20, 2014

PCOR Fee Due July 31st For All Group Health Plans

Fees imposed on certain health insurers and plan sponsors of certain self-insured health plans, known as the Patient Centered Outcomes Research Fee (PCOR Fee or PCORI Fee), will be due on July 31. The fees are a requirement under Health Care Reform to help finance the Patient-Centered Outcomes Research Institute (the “Institute”)1. The Institute is a private, nonprofit corporation established under Health Care Reform to fund research of the clinical effectiveness of medical treatments, procedures, drugs, and other strategies or items that treat, manage, diagnose, or prevent illness or injury.

June 5, 2014

Double-digit premium increases predate PPACA

The latest salvo in the growing debate over Obamacare’s impact on premiums has been launched — this time by no less an authority than one of the architects of both the president’s and Mitt Romney’s health care reform plans. In a new brief published by The Commonwealth Fund, MIT economics professor Jonathan Gruber took a closer look at premium increases before the Patient Protection and Affordable Care Act was enacted. Crunching numbers from the National Opinion Research Center, Gruber shows years of double-digit premium increases before health care reform was even a bill, let alone the law of the land.
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June 3, 2014

The Transitional Reinsurance Fee - FAQs

What is the Transitional Reinsurance Program?
Health Care Reform (“HCR”) directs each state to establish and maintain a "transitional" reinsurance program beginning in 2014 and ending 2016. If the State chooses not to establish a reinsurance program, the Department of Health and Human Services ("HHS") will establish a reinsurance program for the state. The reinsurance program (federal or state) will make payments to any health insurance company that provides health insurance coverage to "high-risk individuals" in the individual health insurance market. In other words, the reinsurance program will provide payments to an insurance company as an incentive or reimbursement for selling insurance products in the individual health insurance market that causes that insurance company to experience unexpectedly high health claims in a particular year on account of insuring such high-cost individuals.
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May 30, 2014

COBRA’s Usefulness Survives PPACA But Is Diminished

COBRA’s usefulness has diminished with the enactment of the Patient Protection and Affordable Care Act (PPACA), but it still is useful in much more limited circumstances, according to Antoinette Pilzner, an attorney with McDonald Hopkins in Bloomfield Hills, Mich. Some employers are wondering why requirements for COBRA (the Consolidated Omnibus Budget Reconciliation Act) coverage have survived the enactment of the PPACA.
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May 29, 2014

Pennsylvania court refuses to enforce non-competition agreement

Most jurisdictions in the United States hold that continued employment constitutes sufficient consideration in exchange for entering into a non-competition agreement. A handful of jurisdictions however – Minnesota, North Carolina, Texas, Washington, West Virginia and (in some cases) Illinois – require employers to provide additional consideration to an employee in order for the non-competition agreement to be enforceable. Add Pennsylvania to this list.
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May 21, 2014

Preparedness for the ACA on an Upswing, but Small Business Lags

With the first round of employer mandates required by the Affordable Care Act (ACA) set to begin in 2015, a new survey finds that employers appear more informed about their companies’ options for providing health insurance.

Sixty-nine percent of U.S. employers report being “very informed” about their options under the ACA in 2014, as compared to only 37 percent in 2013.

The results come by way of an annual survey of employee benefits decision-makers by the nonprofit Transamerica Center for Health Studies. The 2014 survey was conducted in March and April, with the findings report, Pulse Check on Employer Preparedness for the ACA, released in May.
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May 16, 2014

UnitedHealth leads exchange push

May 16 (Bloomberg) -- UnitedHealth Group Inc., once leery of the Patient Protection and Affordable Care Act’s new health insurance exchanges, is starting new plans in at least two states as competition grows stiffer in the government-run marketplaces.

In Washington state, four insurers plan to sell for the first time on the exchange next year, including UnitedHealth. In Virginia, a local health plan owned by a hospital and physicians in Lynchburg has proposed to join Aetna Inc., Kaiser Permanente and WellPoint Inc. in 2015. And in Indiana, the health exchange’s offerings may double to eight companies
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May 5, 2014

Agencies Release ACA/COBRA Guidance

On May 2, 2014, the Department of Labor (“DOL”) issued online updated versions of both the “general” COBRA notice (given upon initial plan eligibility) and the “election” COBRA notice (triggered by a qualifying event). Both notices specifically mention the availability of exchange coverage and the possibility of premium tax credits as an alternative to COBRA coverage for those who are eligible. Similarly, the CHIPRA notice also indicates that premium assistance may be available to those who qualify. Groups should take care to update their template notices accordingly.
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April 29, 2014

Consumers OK with extra PPACA fees

here has been some backlash over companies — including restaurants — adding surcharges to each bill in order to help pay for employees’ health insurance. But it turns out most consumers are OK with the practice.

At least that was the conclusion from a Bankrate.com survey of 1,000 adults, which found that nearly two-thirds of Americans (68 percent) are okay with a business adding a nominal surcharge of 25 cents to each bill in order to help pay for employees’ health insurance. Support for a health insurance surcharge is highest among 18-29 year olds (64 percent) and lowest among Americans ages 65 and older (39 percent).

However, Bankrate.com insurance analyst Doug Whiteman noted that the almost quarter of respondents who don’t agree with the charges can make an impact on the -emerging trend.
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April 28, 2014

Drug info hard to come by on exchanges

New analysis suggests the exchanges didn’t provide enough information on drug coverages or providers for consumers to make an adequate — or at least hassle-free — decision.

A report out Monday from Avalere Health finds that drug coverage information was often elusive and confusing for consumers shopping on the exchanges, highlighting another challenge for the exchanges under the Patient Protection and Affordable Care Act.
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April 24, 2014

For 2015, Higher Limits for HSA Contributions and Deductiblesf

The Internal Revenue Service announced higher limits for 2015 on contributions to health savings accounts (HSAs) and for out-of-pocket spending under high-deductible health plans (HDHPs) linked to them.

In Revenue Procedure 2014-30, issued April 24, 2014, the IRS provided the inflation-adjusted HSA contribution and HDHP minimum deductible and out-of-pocket limits, effective for calendar year 2015. The higher rates reflect a cost-of-living adjustment and rounding rules under Internal Revenue Code Section 223.
A comparison of the 2015 and 2014 limits is shown below:
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April 4, 2014

2015 Cost Sharing Limits Announced

The 2015 maximum annual out-of-pocket limits for all non-grandfathered plans will increase by 4.21%. The confirmed 2015 out-of-pocket limit amounts are $6,600 for individual coverage and $13,200 for family coverage.

The out-of-pocket limits for 2015 stand-alone pediatric dental Marketplace/Exchange plans have increased from the proposed limits. The 2015 confirmed annual out-of-pocket maximum will be limited to $350 for one covered child and $700 for two or more children.

March 31, 2014

Federal agencies issue final regulations on wellness programs under the ACA

Wellness programs have long been subject to myriad federal and state laws. Primary among these are laws involving discrimination rules. Wellness programs are required to satisfy certain criteria in order to be considered non-discriminatory under the Affordable Care Act.
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March 31, 2014

PPACA enrollment may hit 7 million

March 31 (Bloomberg) -- The first yearly sign-up period for Obamacare closes today, with early returns suggesting the administration may near a projection of 7 million enrollees made before the U.S. health exchange struggled at its startup.

The rollout has been under constant attack from Republican foes and faced a key U.S. Supreme Court decision that allowed states to limit the Medicaid expansion that was an important part of the plan. It also suffered from myriad technical flaws in the website that made it unusable for more than a month.
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March 27, 2014

More exchanges bend deadline

More state-based exchange agencies are trying to help consumers get more time to apply for individual commercial coverage without formally changing the March 31 deadline.

Managers of the Maryland exchange announced last week that they’d give consumers who’d made any effort to enroll by March 31 extra time to complete their applications, and managers of the Nevada exchange said they’d offer a 60-day “special enrollment period” to any consumers affected by enrollment system problems.


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March 14, 2014

SHOP marketplace offers choice to small businesses

New research from the Commonwealth Fund suggests that small business owners should consider the Small Business Health Options Program as a means to navigate the choppy waters in this post-Affordable Care Act world through competitive choice.
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March 11, 2014

THE TRANSITIONAL REINSURANCE FEE

Health Care Reform (“HCR”) directs each state to establish and maintain a "transitional" reinsurance program beginning in 2014 and ending 2016. If the State chooses not to establish a reinsurance program, the Department of Health and Human Services ("HHS") will establish a reinsurance program for the State. The reinsurance program (federal or state) will make payments to any health insurance company that provides health insurance coverage to "high-risk individuals" in the individual health insurance market. In other words, the reinsurance program will provide payments to an insurance company as an incentive or reimbursement for selling insurance products in the individual health insurance market that causes that insurance company to experience unexpectedly high health claims in a particular year on account of insuring such high-cost individuals.
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March 10, 2014

Some ACA Non-Compliant Plans Permitted to Remain Until 2016

On March 5, 2014, The Department of Health and Human Services (“HHS”) released guidance extending a prior transitional policy for some ACA non-compliant health plans in the individual and small group health market until October 1, 2016.

On November 14, 2013, the Center for Medicare and Medicaid Services (“CMS”) issued a letter to state insurance commissioners informing them that CMS would allow state regulators to allow insurers to renew non-grandfathered health insurance policies, in the individual and small group market, that did not comply with certain 2014 Affordable Care Act (“ACA”) provisions1 through October 1, 2014. The purpose of this original transitional relief was to combat the problem that arose when several policies were cancelled, late in 2013, due to non-compliance with ACA regulations. A second round of cancellations was expected in fall 2014 at the termination of the transitional relief period.

March 6, 2014

Midsize firms can keep their plans, too

Both small employers and midsize employers that like their coverage might be able to keep it in place until Oct. 1, 2016.

Gary Cohen, the outgoing director of the Center for Consumer Information & Insurance Oversight, raises the possibility in a memo in an “insurance standards bulletin series.” Early Wednesday, news organizations began reporting rumors that CCIIO would be letting individuals keep major medical policies that fail to comply with PPACA insurance standards in force for two more years.
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February 10, 2014

Final Employer Mandate Rules Released

On February 10, 2014, The United States Treasury Department issued the Final Regulations implementing Employer Shared Responsibility Under the Affordable Care Act (ACA) for 2015. This component of ACA is more popularly known as the Employer Mandate or the Pay or Play provision. Basically, this is the section of Health Care Reform that requires certain employers offer certain employees medical coverage or face a penalty.
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January 17, 2014

New laws for HR to heed

As HR managers begin the new year by updating their policy manuals, the Society for Human Resource Management has thoughtfully provided a list of new state laws that took effect on Jan. 1.
California legislators were the most active from an HR manual standpoint, so let’s start there. Its new laws include:
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January 17, 2014

SHOP starts slow as employers stand pat

Jan. 17 (Bloomberg) -- Enollment in Obamacare health plans for small businesses is off to a slow start, leaving in doubt whether the program can attract enough customers to satisfy carriers.
Greeted by higher premiums, less generous coverage and more paperwork, small businesses that offer health coverage to employees are choosing to renew existing plans rather than buy them through President Barack Obama’s program. Complicating matters is the government’s failure to complete the online exchange for small businesses; in 36 states, there will be no website offering ready information on the plans until November.

The program is supposed to help insure the 31 million people who work at companies with fewer than 50 employees. In Kentucky, just 14 companies signed up for Obamacare’s small business plans as of Jan. 1, while Colorado enrolled 101, and Connecticut 106. “Lousy,” said Kevin Counihan, the chief executive officer of Connecticut’s health exchange, Access Health CT. “We’ve done a very good job on the individual side. We’ve dropped the ball on the small-business side.”
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December 12, 2013

HSA participation prompts higher employee engagement

There’s some good news for those who fear that putting health care financial decisions in the hands of employees might produce nothing but confusion. Like what you see?

Sign up for Employee Benefit News daily newsletter to get the latest news and important insight into trends in benefits management. Instead, a new survey indicates that employees who actively contribute to their HSAs do indeed become more engaged and involved in managing their health. Buck Consultants, polled 23,000 members of the BenefitWallet HSA system and found that more than half of those actively participating in their HSA had made the effort to set aside more money for potential medical costs than they had before enrolling.
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December 10, 2013

Health Care and Seasonal Employees: Mind the Minefields

Seasonal workers can cause significant problems for employers because of the new requirements of the Affordable Care Act (ACA). Here are some of the most significant issues to consider: Do the company’s seasonal employees push it into “large” employer status so that because of the seasonal workforce the company must offer health care coverage to all full-time employees? Under the ACA, “large” employers must offer health care coverage to all “full-time” employees. An employer is considered a “large” employer in a given calendar year if it employed an average of 50 or more employees in the previous year. An employer that is considered a “small” employer during a year will not be subject to the employer mandate the next year. Seasonal workers that work 120 or fewer days during the year are not considered employees for purposes of determining whether the company is a large or small employer. Thus, employers can exclude certain seasonal workers from this calculation if they plan well.
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November 27, 2013

IRS Sets Health Tax Rules

The Internal Revenue Service is taking a tough approach on which benefits plans and carriers will have to pay the new federal health insurance tax in 2014. Section 9010 of the Patient Protection and Affordable Care Act requires health plans and commercial insurers to pay $8 billion in new taxes in the coming year, and more in later years, to help compensate for the new, subsidized business PPACA is supposed to send to carriers. The “covered entities” subject to PPACA Section 9010 will have to pay a flat, per-person tax using Form 8963.
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November 27, 2013

Small business Obamacare online enrollment delayed a year

The Obama administration today announced a one year delay of online enrollment for small businesses looking to purchase health coverage through federal Obamacare exchanges, another high-profile setback for HealthCare.gov. It’s the second delay for online small business enrollment, which the administration had said would begin this month.
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November 8, 2013

HHS unveiling rules for mental health coverage

(Bloomberg) -- Insurers will be required to cover mental illness to the same degree as physical ailments as the Obama administration moves forward with the largest U.S. expansion of behavioral health care in a generation. Five years after the Mental Health Parity act was passed, and almost a year after the Sandy Hook shooting, regulations to fully implement the law are being released today. The new rules mean insurers won’t be able to charge higher co-payments or deductibles for mental illness or limit the duration of care.
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November 7, 2013

‘Free’ PPACA coverage may cost more

Thanks to federal subsidies, as many as 6 million people who are uninsured, and another 1 million with individual plans, may qualify for “free” health insurance under the Patient Protection and Affordable Care Act, according to an analysis by the consulting giant McKinsey. But free, in this case, might not be as cheap as it sounds. MoneyWatch’s Ray Martin, a financial advisor and commentator, ran some numbers the other day and concluded that “free” coverage will likely cost most folks more over time than if they chose to pay a monthly premium. It’s not news to benefit professionals, but it’s all about the differences between the free insurance for certain qualified individuals and families, and the price of the cheapest bronze or silver options available on the various public exchanges. “While the prospect of getting health insurance for ‘free’ may sound appealing, it may not be the best way to go,” Martin says.

He notes that the cheapest plans are the bronze ones, “typically priced so that the costs can be about the same as the federal subsidies.”
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November 7, 2013

State exchanges keep plugging away

Local Web problems, federal data hub problems, bad publicity, a reduction in pent-up demand or simple Halloween distraction all could have been responsible for sluggish activity on the Colorado and Rhode Island exchanges during their fifth week of operation. Managers of the Connect for Health Colorado and the HealthSource RI report lower weekly application and enrollment figures in their latest updates. The Patient Protection and Affordable Care Act enrollment period began Oct. 1. At the Colorado exchange, the number of new accounts slipped to 7,607, down from a weekly average of 11,000.

The number of consumers enrolled in private health insurance through the exchange fell to 244, from a weekly average of about 800.
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October 10, 2013

Updated Health Care Reform Timeline

Provides short summaries/descriptions of all of the provisions of Health Care Rerform, including links to Benecon communications and other websites for additional information. We will update this document as new guidance and regulations are released.
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October 3, 2013

What you need to know about the cap on out-of-pocket spending delay

Since the Congressional Research Service reported that the Obama administration had missed as many as one- third of ACA's legally required deadlines - and that report was circa November 2011 - the government has announced it won't be able to verify individuals' eligibility for ACA exchange subsidies until 2015 - relying on "the honor system" for a full year. Also delayed 12 months is the employer mandate requiring those with more than 50 employees to offer health care. And even while benefits administrators are still planning around that change, another yearlong delay has come to the fore: limits on out-of-pocket spending.
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October 1, 2013

Health Insurance Marketplace Opens, Offers Millions of Americans Quality, Affordable Health Care Coverage

For the first time ever, today all Americans can begin shopping for quality health coverage that is affordable, and not be denied or charged more because they have a pre-existing condition. The Health Insurance Marketplace is a new, simpler way for uninsured Americans and their families to purchase health insurance in one place. Coverage begins as early as January 1, 2014 for people enrolling by December 15, 2013. Today also marks the kick-off of outreach and enrollment activities in communities nationwide. Enrollment events will take place in a variety of local settings including public libraries, churches, festivals, sports events, and community meetings.
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September 26, 2013

How employers can get paid to add wellness

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September 9, 2013

Small businesses unaware of health coverage notification rule

Small business owner, make this note to self: “I will notify my employees of their options for health coverage under the Patient Protection and Affordable Care Act.” Numerous studies suggest that employers are far behind in getting the required notice about state health insurance exchanges, in writing, to employees by Oct. 1. Particularly at risk are small businesses. Employers with few than 50 full-time workers will not be required to offer health coverage to their workforce. But, they are still required under the PPACA to inform their employees about the existence of state health exchanges. Many small businesses are unaware of this obligation, benefits consultants are reporting. With the Oct. 1 deadline quickly approaching, these companies need to get the word out if they want to avoid paying a fine of $100 per worker per day.
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September 6, 2013

9 Items to Tackle Ahead of The October 1 Deadline

Enrolling employees for the 2014 company health plan will put plan managers to a test like they’ve never seen before. Those that haven’t already immersed themselves in the details are going to be working some very late nights in the next couple of weeks. John Haslinger, vice president for strategic advisory services at ADP, helped BenefitsPro.com compile a list of the essentials that must be executed in order to comply with the law and avoid sanctions.
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September 3, 2014

Does out-of-pocket delay actually apply to you?

et another Affordable Care Act delay is in the spotlight: limits on out-of-pocket spending. According to the law, starting in 2014, health plan participants will be spending no more than $6,350 in total out-of-pocket costs for individuals and $12,700 for family plans. That cap on out-of-pocket spending has been delayed until 2015, however, if an employer is using two separate vendors for its medical and pharmacy benefits. Sandy Ageloff, southwest health & group benefits leader for Towers Watson, says the rule only applies “to nongrandfathered plans” and emphasizes that the delay only applies to those who split their services. “So the biggest piece of the legislation,” Ageloff says, “is that compliance is still required for Jan. 1, 2014 if the benefit plan – whether it’s a self-funded employer plan or a fully insured carrier program – is using a single vendor for the administration of both medical and pharmacy. The nuance comes in when you have multiple vendors, you get a one-year deferral in total compliance. You still have to comply in pieces, but you don’t have to comply in total.” The number of plans that maintain their grandfathered status in the face of ACA continues to shrink, but Ageloff estimates that 35% or 40% of large employers use different vendors and thus have the extra year. Complicating things, she says, is that “a number of carriers actually have, behind the scenes, carved out that relationship with a pharmacy vendor,” so two can masquerade as one. Figuring out compliance may require more than just a phone call to your provider.
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August 30, 2013

Individual Mandate Final Regulations

IRS ISSUES FINAL REGULATIONS REGARDING THE INDIVIDUAL MANDATE The IRS has recently issued the final rule governing the Affordable Care Act’s (“ACA” or “Health Care Reform”) Individual Shared Responsibility Provision. This provision is more commonly known as the Individual Mandate. This provision requires most individuals to obtain and maintain “Minimal Essential Coverage” for themselves and their children or pay a penalty. While the implementation of the other well-known ACA shared responsibility provision, known as the Employer Mandate or Pay or Play, has been delayed, it is important to note that the Individual Mandate has not been delayed.
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August 23, 2013

Push for 40-hour health care threshold will take work

In mid-July, the IRS issued guidance, Notice 2013-45, on the one-year delay of the Affordable Care Act's employer mandate, announced in a U.S. government blog earlier in the month. First and foremost, the guidance made the delay official, but what's more, it defines what the delay doesn't change, and, in many cases, leaves unclear. "It made it very clear that the transition relief for the extension only applies for purposes on these reporting forms and has no effect on anything else," says Paul Hamburger with Proskauer. "At this point, it is only the application of the fees for the mandate, and the reporting of the information on those forms." And naturally, any delay offers the opportunity for further change to the ACA. While many proposed changes, like a Republican push to nix the individual mandate, have little chance of becoming reality, others, like a shift in the matrices for determining who is a full-time worker, could well find footing in the next 12 months. Under the ACA, employees working more than 30 hours per week are considered full time.
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August 22, 2013

The Future of HRAs with ACA by Basic

Beginning January 1, 2014, the uses to which a health reimbursement arrangement (HRA) may be put will be limited by Health Care Reform (HCR). Certain types of HRAs will no longer be able to accept contributions. However, a number of useful HRA design options will continue to be viable on and after January 1, 2014. Learn how to inventory employer needs, evaluate existing programs, identify potential compliance issues, and modify HRA plan designs to remain viable on and after January 1, 2014.
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Employer Mandate May Be Delayed But Deadlines Still Exist

On July 2, the Obama administration postponed the Patient Protection and Affordable Care Act employer mandate penalties for one year until 2015.
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August 16, 2013

Obamacare Likely To Have a Rocky Start, Panel Says

Small business owners and consumers who are scheduled to begin shopping for health insurance on the Obamacare exchanges in less than two months better buckle up for a bumpy ride, a panel of benefits experts said at an employer roundtable Friday in Bethlehem Township.
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July 31, 2013

Exchanges lost in translation

It’s hard enough to figure out the intricacies of the emerging state health insurance exchanges without having to surmount a language barrier. Yet, according to a report from the Pacific Northwest, that’s exactly what many immigrants are encountering.
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July 18, 2013

6 things to know about state-based exchanges

The emerging state insurance exchanges suggest that states’ rights are alive and well.

As the implementation of portions of the Patient Protection and Affordable Care Act approaches, state exchanges are beginning to take form and substance. The Commonwealth Fund surveyed all 50 states and the District of Columbia to see how things were going, and found plenty of diversity among the characteristics of the various exchanges.
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July 17, 2013

8 reasons for employers to keep their PPACA guard up

Now that the celebrations have died down over the one-year delay of penalties for employers who don’t meet the PPACA coverage requirements, it’s time to take a close look at what does remain in effect. The very short answer to the question is that there’s still quite a bit on the books, and that, really, only the teeth have been (temporarily) removed. Here’s what the national law firm Bryan Cave had to say about which PPACA provisions remain in effect for employers in the year ahead.
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July 15, 2013

HealthCare Reform Legislative Brief – Employer Mandate Delayed until 2015

The Obama Administration has postponed the Affordable Care Act (ACA) employer mandate penalties for one year, until 2015. The Department of the Treasury announced the delay on July 2, 2013, along with a similar delay for information reporting by employers, health insurance issuers and self-funded plan sponsors. The delay does not affect any other provision of the ACA, including individuals’ access to premium tax credits for coverage through an Exchange. The Treasury plans to issue more formal information about the delay within a week.
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July 10, 2013

Transitional Guidance Released Regarding Pay or Play and Information Reporting Delay

This bulletin applies only to employers with more than 50 employees.
The IRS has issued transitional guidance on the delay of information reporting and the employer shared responsibility (Pay or Play) provisions of the Affordable Care Act. Please click here for more information.
This BeneFlash is provided for information purposes only and does not constitute legal advice. It contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation, or requirement. Benecon serves employers and producers in Pennsylvania. Information contained in this newsletter is applicable to federal and Pennsylvania laws and regulations. Depending on the specific facts and location of any situation, there may be additional or different requirements. Please use this BeneFlash as a guide and not as a definitive description of your compliance obligations.
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July 7, 2013

Continuing to Implement the ACA in a Careful, Thoughtful Manner

Over the past several months, the Administration has been engaging in a dialogue with businesses - many of which already provide health coverage for their workers - about the new employer and insurer reporting requirements under the Affordable Care Act (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.
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July 2, 2013

PPACA employer mandate delayed until 2015

A report out just last month from the Government Accountability Office also pointed to challenges in opening the federal exchanges on time, underscoring the challenges the administration has in the coming months. The new employer mandate delay was enough ammo for critics of the law to continue their attacks. Senate Minority Leader Mitch McConnell said that the delay confirms that "Obamacare costs too much and it isn’t working the way the administration promised.” Business groups welcomed the news. "A pleasant surprise," said Randy Johnson, senior vice president of the U.S. Chamber of Commerce. There was no advance warning of the administration's action, he said. The National Retail Foundation called the delay a "wise move."
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June 27, 2013

Employee Notification of Exchange

Before October 1, 2013, employers must notify their employees about the availability of Health Exchange/Marketplace. In Michigan the Exchange will be called Mi Health Marketplace. In summary, this requirement applies to essentially all employers and requires you, as an employer, to provide the Exchange Notice to all of your employees.

Following are some frequently asked questions and the answers regarding this requirement:
Which Employers? With some very limited exceptions, all employers, regardless of the number of employees and regardless of whether or not you currently offer a group health insurance plan must provide the Exchange Notice.
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June 26, 2013

HHS Continuing ACA Outreach Efforts.

Following Monday’s launch of the Obama Administration’s major Affordable Care Act education campaign, several outlets continue coverage and analysis of the effort. The NPR (6/26, Gold) “Shots” blog reports on the importance of Latinos to the success of the Affordable Care Act, noting that the Obama Administration is “pulling out all stops” to make sure they sign up.

For example, Health and Human Services Secretary Kathleen Sebelius “will be making the rounds on Spanish-language media outlets to discuss the health law and the newly revamped CuidadoDeSalud.gov, the Spanish version of HealthCare.gov.” As the article explains, not only do Latinos make up 17% of the American population, they make up one-third of those that are uninsured. Further, “nearly half of Hispanics are under the age of 26,” and youth are a crucial demographic to the law.
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June 21, 2013

Welcome to the new HealthCare.gov!

Health insurance is changing in important ways in 2014. We’ve updated HealthCare.gov to help you get ready for those changes, especially one of the most important: the opening of the new Health Insurance Marketplace.

Answering your questions about health coverage
Our mission is to help you understand your new health coverage options so you can enroll in a plan that works for you and your family. If you run a small business, we’ll help you find a plan that works for you and your employees. Self-employed? We’ve got that covered too.
Click here for full article

June 20, 2013

Attention Employers with Self-Insured Health Plans: PCOR Fees Due July 31

Under the Affordable Care Act, certain insurers and self-insured health plans are responsible for paying fees to help fund the Patient-Centered Outcomes Research Institute. The PCOR fees are reported and paid on Form 720 once a year and are due no later than July 31 of the year following the end of the plan year. The fees are first due July 31, 2013. Form 720 has now been revised to include the PCOR fees and is available on the IRS website for use for the rapidly approaching July 31 deadline. Revised Form 720
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June 10, 2013

15 PPACA provisions that will take effect in 2014

The effective date of the Patient Protection and Affordable Care Act (PPACA) was March 23, 2010, although various provisions have their own effective dates from January 1, 2010, (the small business income tax credit) through 2018. The start of 2013 saw the launch of a number of key provisions, among them Medicare tax increases, limits on Health FSA deferrals and the requirement that W-2 reporting note employer and employee payments for certain health care items in 2012.
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June 6, 2013

Form 720 Revised for PCOR Fee

IRS RELEASES REVISED FORM 720: FROM TO BE USED BY SELF-FUNDED GROUPS TO PAY AND REPORT THE FEE TO SUPPORT THE PATIENT CENTERED OUTCOMES RESEARCH INSTITUTE (the “PCOR FEE”)

After months of waiting, the Internal Revenue Service has issued the revised Federal Form 720. This form will be used by all groups that maintain a self-funded plan in order to pay the upcoming PCOR Fee. All calendar year plans, and certain fiscal year plans, will be required to pay this fee by July 31, 2013. Other plans will not be required to pay this fee until July 31, 2014. Third parties (including TPAs) cannot file the Form 720 on behalf of a group. A group must submit the form directly to the IRS.
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June 4, 2013

Wellness Plans and Health Care Reform FAQs

FINAL RULES ISSUED:
WELLNESS PLANS AND HEALTH CARE REFORM FAQs

Recently, the Departments of Health and Human Services, Labor and Treasury jointly issued the final rules related to wellness plans and Health Care Reform. These rules impact existing wellness plans, and also provide guidance for employers wishing to establish wellness plans in the future. The final regulations make some substantial changes to the proposed regulations, issued earlier in 2013. Most notably, the new regulations create two new sub-categories of health-contingent wellness plans. Proper identification of a wellness plan will be crucial when determining compliance requirements.
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May 23, 2013

Employers Asked to Complete “Coverage Tool”

In May 2013, the Department of Health and Human Services (“HHS”) issued a new and more streamlined application package to be used by individuals seeking to enroll in individual health coverage through a public exchange (also known as a marketplace). The new package of applications includes three versions:
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May 8, 2013

GUIDANCE ON THE EXCHANGE/MARKETPLACE NOTICE LANGUAGE RELEASED INCLUDING MODEL LANGUAGE

On May 8, 2013, the Department of Labor issued guidance on the requirement for employers to provide all employees with notices regarding the existence of, and identification of services offered through, the Exchange (now known as the Marketplace). This requirement was originally slated for implementation on March 1, 2013, but was delayed. Now, employers must provide the notice to their employees no later than October 1, 2013.
Click here for full article

April 30, 2013

Laying Bare Your Finances to Apply for Health Care

WASHINGTON — After a storm of complaints, the Obama administration on Tuesday unveiled simplified forms to apply for insurance under the president's new health care law. You won't have to lay bare your medical history but you will have to detail your finances.

An earlier version of the forms had provoked widespread griping that they were as bad as tax forms and might overwhelm uninsured people, causing them to give up in frustration. .

The biggest change: a five-page short form that single people can fill out. That form includes a cover page with instructions and another page if you want to designate someone to help you through the process. .

But the abridged application form for families still runs to 12 pages, even if most households will not have to fill out every page. Most people are expected to take another option, applying online. .

The ease or difficulty of applying for benefits takes on added importance because Americans remain confused about what the health care law will mean for them. A Kaiser Family Foundation poll released Tuesday found that 4 in 10 are unaware it's the law of the land. Some think it's been repealed by Congress. In fact, it's still on track.
Click here for full article

April 29, 2013

Physicians Flocking to ACO Models

Though physicians haven’t been on board with all of President Obama’s solutions to health care, they are embracing at least one approach. .

The number of physicians participating in the emerging medical care delivery system known as accountable care organizations has tripled in the past year, according to new research. .

Nearly one in four doctors are in or planning to link with an accountable care organization within a year, a new Medscape study found. By comparison, only 8 percent of physicians in last year’s report said they were in or planning to join an ACO. Medscape’s report analyzed responses from nearly 22,000 U.S. physicians across 25 specialties. .

“There’s a dramatic change in the number of physicians who are becoming involved in accountable care organizations,” the report said. “The focus on ACOs as a care-delivery and cost-containment method is making an impact.” .

ACOs were created under the Patient Protection and Affordable Care Act with the intent of improving care while lowering costs. .

Under the ACO model — which brings together groups of hospitals, doctors and other health providers to direct patient care — organizations are paid for caring for a pool of patients rather than for each procedure. Groups receive a percentage of the savings they generate for Medicare as an incentive for keeping costs low.
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April 22, 2013

Enticing and Guiding Employees to Using Work Wellness Programs

Typical wellness programs struggle to maintain employee participation rates above 15 percent to 20 percent. But there are ways to increase that number by successfully implementing programs and by maintaining engaged employees. These methods include using your insurance carrier to its fullest, surveying employees, providing incentives and, as managers, leading by example. Here are five key steps for a successful and sustained wellness campaign :
Click here for full article

April 18, 2013

Massachusetts: Our Exchange Users Like Their Plans

The managers of the model for the new Patient Protection and Affordable Care Act health insurance exchange system -- the Massachusetts exchange program -- say low-income and moderate-income users seem to be happy with the program. .

But officials at the Commonwealth Health Insurance Connector Authority have found an increase in the percentage of users who have been uninsured, at least temporarily, since they signed up for the exchange. .

In related news, a team of outside researchers led by Alison Galbraith of Harvard found that about 60 percent of Massachusetts exchange users with two or more children and incomes under 400 percent of the federal poverty level reported that they found that paying for health care was a serious financial burden. .

"We conclude that those with lower incomes, increased health care needs and more children will be at particular risk after they obtain coverage through exchanges in 2014," Galbraith and her colleagues wrote in a paper published in Health Affairs, a health finance and health policy journal. "Policy makers should develop strategies to further mitigate the financial burden for enrollees who are most susceptible to encountering higher-than-expected out-of-pocket costs, such as providing cost calculators or price transparency tools." .

Health Connector managers came up with the data for their analysis by conducting a telephone and mail survey of exchange users who qualify to enroll in subsidized Commonwealth Care plans. .

About 84 percent of the 857 survey participants said they are satisfied or extremely satisfied with the Commonwealth Care program, up from 77 percent in 2012. The percentage who said they were extremely dissatisfied held steady at 2 percent.
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April 16, 2013

Updated: Health Care Reform Timeline

Health Care Reform Timeline - New 4/16/13: provides short summaries/descriptions of all of the provisions of Health Care Rerform, including links to Benecon communications and other websites for additional information. We will update this document as new guidance and regulations are released.
Click here for full article

April 15, 2013

Insurers flock to private exhanges

The fate of public exchanges under health reform is still up in the air as states struggle with implementation, but private exchanges are gaining momentum among insurers and employers alike. .

Health consulting firm Mercer said that 10 major insurance carriers—including Aetna, Cigna, Humana, UnitedHealthcare and a number of Blue Cross and Blue Shield plans—have signed on to the firm’s private exchange for 2014 enrollment. .

The consulting firm in January announced the launch of Mercer Marketplace, a private benefits exchange designed to help employers and employees by offering them a one-stop-shop for their benefits from multiple insurance providers. .

“With 56 percent of employers considering a private exchange to provide benefits to their active employees or retirees, the transformation of the U.S. health care landscape is well under way,” David Rahill, president of health and benefits at Mercer, said in a statement.
Click here for full article

April 15, 2013

The Wellness Path Not Taken

With full implementation of health care reform marching along, the landscape of employer-sponsored health benefits will never be the same. As employers turn to private and public exchanges beginning in 2014 as allowed under the Patient Protection and Affordable Care Act, the purpose for and implementation of worksite wellness programs also are likely to change.
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April 3, 2013

Full Operation of Small Business Health Options Program (SHOP) Delayed until 2015

This Health Care Reform Bulletin applies to employers with 100 or fewer employees.
On March 1, 2013 CMS and HHS released the final rule setting forth the standards for the administration of SHOP Exchanges. HHS concurrently issued a proposed rule suggesting a transitional policy regarding employees’ choice of qualified health plans (QHPs) in the SHOP program. Beginning in 2014, state-based health insurance Exchanges will begin operations. Individuals and small businesses will be able to purchase private health insurance through the Exchange.
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April 3, 2013

Feds release rules for exchange ‘navigators’

The Obama administration on Wednesday released a proposed rule outlining the standards for "navigators” who will help consumers shop for health insurance in new exchanges set up by the Patient Protection and Affordable Care Act. Navigators are organizations that will provide unbiased information to consumers about health insurance, the new health exchanges, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program. “Navigators will be an important resource for consumers who want to learn about and apply for coverage in the new marketplace,” Centers for Medicare & Medicaid Services Acting Administrator Marilyn Tavenner said in a statement.
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April 1, 2013

Small Firms’ Offer of Plan Choices Under Health Law Delayed

WASHINGTON — Unable to meet tight deadlines in the new health care law, the Obama administration is delaying parts of a program intended to provide affordable health insurance to small businesses and their employees — a major selling point for the health care legislation. The law calls for a new insurance marketplace specifically for small businesses, starting next year. But in most states, employers will not be able to get what Congress intended: the option to provide workers with a choice of health plans. They will instead be limited to a single plan.
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March 28, 2013

Proposed Rule on 90-Day Waiting Period Limit for Health Plans

On March 21, 2013, federal agencies published in the Federal Register proposed regulations on a requirement under the Patient Protection and Affordable Care Act (PPACA) that prohibits group health plans and health insurance issuers offering group health insurance coverage from imposing any waiting period that exceeds 90 days. A waiting period is defined as the period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll under the terms of a group health plan can become effective. The new regulations implement this requirement, as well as amend existing requirements—such as preexisting condition limitations and other portability provisions added by the Health Insurance Portability and Accountability Act (HIPAA)—to conform them to other PPACA provisions. Some key elements of the proposal are as follows:
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March 25, 2013

Health Care Reform Update March 25, 2013 - National Law Review

Leading the News On March 21st the House approved a stopgap spending measure by a 318-109 vote that avoids a government shut down for the next six months. Opponents of the continuing resolution (CR) said it did not offer adequate funds for the Affordable Care Act (ACA). Democrats who supported the CR say it was the best bill that could be agreed upon at the time. An article on the House vote can be read here.
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March 23, 2013

State Legislation and Actions Challenging Certain Health Reforms

In response to the federal health reform law, the Patient Protection and Affordable Care Act (PPACA or just ACA)*, and separate state reform initiatives, some members of at least 47 state legislatures proposed legislation to limit, alter or oppose selected state or federal actions. On June 28, 2012 the U.S. Supreme Court upheld most provisions of the Patient Protection and Affordable Care Act, but rejected the portion of the law that would have penalized states that did not comply with the expanded eligibility requirements for Medicaid. The law called for cutting off all Medicaid funding to states that did not go along with the expanded eligibility provision. NCSL will continue to update and analyze the law and its effects on states. > See latest information at U.S. Supreme Court and the Federal Health Law. As of Mid-March, 2013, 20 state legislatures had enacted laws and measures related to challenging or opting out of broad health reform including the Patient Protection and Affordable Care Act (PPACA).
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March 21, 2013

On Private Health Exchange, Choice Drives Satisfaction (SHRM)

Data on the use of the first large private health exchange for U.S. employers providing an online platform for active employees to purchase employer-subsidized coverage?eveal that enrollees chose the health plan they felt offered the best value for themselves and their family, and liked being able to select among multiple carriers. The multi-insurer private (or "corporate") exchange, created by consultancy Aon Hewitt, began operating in the fall of 2012 for plan year 2013. Subsequently, a number of other large HR consultancies, including Towers Watson, Mercer and Buck Consultants, created their own private exchanges for plan year 2014 or announced plans to do so. Unlike the public, government-run exchanges scheduled to launch this fall for plan year 2014, private exchanges do not provide a conduit for the government to subsidize the purchase of policies by low-income employees. Instead, private exchanges let employers provide eligible workers with an employer subsidy to purchase policies that comply with the federal Patient Protection and Affordable Care Act (PPACA) and meet the specifications of state insurance regulators.
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March 1, 2013

Obama administration unveils health insurer fees Criticism is swift–and harsh

The Internal Revenue Service on Friday unveiled its proposal to raise billions of dollars through annual fees on health insurers, a “$100 billion health insurance tax rule” that the industry says will significantly drive up costs for consumers. The rule as part of the Patient Protection and Affordable Care Act imposes annual fees on health insurers that start at $8 billion in 2014, increases to $14.3 billion in 2018, and will increase every year after that. The Joint Committee on Taxation estimates the tax will exceed $100 billion over the next ten years. The proposed rule will be published Monday for public consideration in the Federal Register. The IRS will accept comments for 90 days, beginning Monday. Not paying on time will result in a $10,000 penalty for insurers, plus $1,000 for every day they miss deadline.
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February 26, 2013

How will HRAs and HSAs work on public exchanges?

The answer to that question is still fuzzy. That’s because while the Department of Health and Human Services has confirmed to Employee Benefit News that health reimbursement arrangements and health savings accounts will be offered on the public exchanges, the organization still hasn’t released the details and regulations surrounding these accounts. So where do industry leaders think we’re headed with these accounts?
Click here for full article

February 4, 2013

Fewer Part-Time Workers Elect Health Care Coverage

Among eligible part-time workers, fewer elect health care benefits at large companies in comparison to full-time employees, according to the 2012 Study of Large Employer Health Benefits by ADP. While 88 percent of full-time respondents are eligible for benefits, 77 percent enroll for health coverage. Thus, 67 percent of the total full-time work force is covered. Part-time respondents make up 23 percent of the total work force, and only 53 percent of those respondents elect employer health care coverage. Based on this figure, part-time respondents represent less than 5 percent of employees enrolled in employer health care coverage.
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January 28, 2013

Your Prescription for Surviving Health Care Reform

If you currently offer health insurance to your employees then you most certainly have an insurance agent or consulting firm that handles your employee benefits. That insurance agent gets a check from the insurance company every month regardless of whether they are actively working for you or not..
Click here for full article

January 28, 2013

New Health Care Markets on the Way

WASHINGTON (AP) — Buying your own health insurance will never be the same. This fall, new insurance markets called exchanges will open in each state, marking the long-awaited and much-debated debut of President Barack Obama's health care overhaul. The goal is quality coverage for millions of uninsured people in the United States. What the reality will look like is anybody's guess — from bureaucracy, confusion and indifference to seamless service and satisfied customers.
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January 22, 2013

Employer Mandate Explanation

On December 28, 2012, the Internal Revenue Service (the “IRS”) released proposed regulations under Code Section 4980H (54.4980H-1, 2, 3, 4 and 5) relating to the employer shared responsibility provisions (the “Employer Mandate”) under Health Care Reform. These regulations follow prior guidance, makes changes, provides clarifications and includes important transition relief. The following has been revised to include these important provisions.
Click here for full article

January 10, 2013

Agencies Offer Guidance on PPACA Taxes, Fees

In regulations and other pronouncements issued toward the end of 2012, the government has provided further details on new taxes and fees introduced by the Patient Protection and Affordable Care Act. Health plan sponsors will be particularly interested in the amounts that they will be assessed to fund various PPACA programs. This guidance includes:

Click here for full article

As you may know, beginning in 2014, employers with more than 50 full-time equivalent employees may be subject to a penalty tax if they do not offer health care coverage to all full-time employees (and their dependents). These employers may also be subject to a penalty if they offer coverage that is unaffordable or does not provide minimum value.

These penalties, known as the “Pay or Play” penalties, will affect an employer if any full-time employee purchases health insurance through an exchange and receives a tax credit or cost-sharing reduction for that coverage.

BSI Corporate Benefits has access to Pay or Play Calculator tools through licensed carriers and business partners. BSI determines, on an individual basis, which Pay or Play Calculator is best suited for each client. BSI uses these tools to advise each organization on current coverage, potential penalties and proposed benefit plan changes and best course of action.

Please contact us today to find out how these “Pay or Play” penalties may affect your company.
Tony DaRe – Agency Principal
Tel: 877-413-6417
Email Tony

“Pay or Play” Topic - Health Care Reform News:

October 6, 2015

Reporting for ACA Mandates: Final Forms and Additional Guidance

The IRS has finalized the 2015 forms and instructions for reporting under the individual and employer mandates and issued additional guidance on these new reporting requirements. The following forms are now available:

  • Form 1094-B
  • Form 1095-B
  • Form 1094-C
  • Form 1095-C
  • Instructions for Forms 1094-B and 1095-B
  • Instructions for Forms 1094-C and 1095-C

Click here for full article

August 19, 2015

Law Excludes Veterans from ACA Mandate; Questions Remain

Under the Surface Transportation and Veterans Health Care Choice Improvement Act, signed into law by President Barack Obama on July 31, 2015, employers may exclude full-time employees who served in the U.S. military—and who currently receive veterans’ health insurance—from the Affordable Care Act’s 50-or-more full-time employee threshold count. In order for the exclusion to apply, the veterans’ coverage must be either through Tricare (the federal veterans' health program) or through the Veterans Affairs Department. - See more at: http://www.shrm.org/hrdisciplines/benefits/articles/pages/veterans-aca-mandate.aspx#sthash.sowaNurw.dpuf
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July 30, 2015

Overview of the Employer Shared Responsibility Provisions

The Affordable Care Act contains specific responsibilities for employers. The size and structure of your workforce – small, large, or part of a group – helps determine what applies to you. Employers with 50 or more full-time equivalent employees will need to file an annual information return reporting whether and what health insurance they offered employees. In addition, they are subject to the Employer Shared Responsibility provisions. All employers that are applicable large employers are subject to the Employer Shared Responsibility provisions, including federal, state, local, and Indian tribal government employers. An employer’s size is determined by the number of its employees. Generally, if your organization has 50 or more full-time or full-time equivalent employees, you will be considered a large employer. For purposes of this provision, a full-time employee is an individual employed on average at least 30 hours of service per week.
Click here for full article

June 25, 2015

ACA’s Employer Mandate Survives in Wake of High Court Ruling

The Affordable Care Act’s (ACA’s) employer mandate is alive and well, even in states that don’t have their own health care insurance exchanges and where the federal exchange is filling the void, thanks to a June 25, 2015, U.S. Supreme Court decision. webinars The decision held that the ACA’s tax credits are available in states that have a federal rather than state exchange. If the court had ruled the other way and held that tax credits were not available in the 34 states where only the federal exchange operates, no one in those states would get subsidies. So employers in those states would not have been subject to the employer mandate anymore, explained Robert Projansky, an attorney with Proskauer in New York City. - See more at: http://www.shrm.org/legalissues/federalresources/pages/federal-exchange-subsidies.aspx#sthash.IgLrSymq.dpuf
Click here for full article

June 16, 2015

6 things to expect if SCOTUS kills subsidies

The Supreme Court is expected to make a ruling on the King v. Burwell case any day now. The case ultimately hinges on just four words — “established by the state" — as it calls into question the legality of federal exchanges. While PPACA challengers say that phrase limits the tax credits to the 16 states that have set up their own exchanges, the Obama administration has defended an IRS rule that interpreted the law as allowing subsidies nationwide. Regardless, it's anyone's guess what the Court will do. But here are 6 things that would happen should SCOTUS gut the subsidies under the Patient Protection and Affordable Care Act.
Click here for full article

May 12, 2015

The Affordable Care Act in 2015: The Employer Mandate "Gets Real"

It? time to put the rhetoric aside and figure out how service businesses will comply with the new rules Few Americans remain on the fence about the Affordable Care Act (ACA). Regardless of the politics that surround the law, 2015 is the year that employers who cross the 50-employee threshold must track and report the coverage that they provide to employees. Those who fail to count and offer coverage to employees as the law requires may face significant penalties. Even employers who have performed this count before can benefit from taking some time to review records, determine whether or not their businesses are subject to the mandate and, if so, which employees they?e required to cover.
Click here for full article

May 1, 2015

Will Your Company Pay or Play

Beginning in 2015 and 2016, many employers will have to provide health insurance for their employees, or pay a penalty to the government. This is called "employer mandate".
Click here for full article

April 28, 2015

The Affordable Care Act: Does the 2015 Employer Mandate Apply to Your Company?

he main objective of the Affordable Care Act (ACA), is to make affordable health coverage available to every American citizen, regardless of health status or income level. Individual Mandate. The ACA’s individual mandate – also known as “enroll-or-pay” – required individuals who did not have minimum essential health coverage, as defined by the ACA, beginning January 1, 2014 to qualify for an exemption or delay, or pay a tax penalty. Employer Mandate. To ensure that individuals had the opportunity to obtain such coverage, the ACA imposed an employer mandate – also known as “shared responsibility” – to Applicable Large Employers (ALEs) effective January 1, 2015. The employer mandate requires ALEs, as defined by the ACA for 2015, to offer minimum essential medical coverage that is both adequate and affordable, or pay a tax penalty.
Click here for full article

March 18, 2015

Obamacare's Employer Mandate Didn't Help Company Enrollment

Despite the Affordable Care Act’s controversial requirement that employers provide coverage for workers or face stiff penalties, companies saw “virtually no change” in enrollment growth from 2014 to 2015, a new survey of large companies shows. The survey of nearly 600 employers by Mercer, an employee benefits consultancy, is somewhat surprising given the political fallout surrounding the employer mandate, which was delayed until 2015 for large employers with 100 or more full-time employees. Employers feared higher costs from an influx of enrollees when they were required to offer coverage.
Click here for full article

March 3, 2015

Fate of Obamacare's employer mandate rests with U.S. Supreme Court

On March 4, the U.S. Supreme Court will hear oral arguments in King v Burwell, a case that will have a critical impact on Obamacare, as well as millions of individuals around the country and most Texas employers. In this case, the Supreme Court will decide whether premium assistance under the Affordable Care Act, or ACA, is available only to individuals that obtain health insurance through a state operated health insurance exchange. Texas and 33 other states have opted not to implement a state exchange, and the exchange that operates in these states was established by the federal government. How did this case get to the Supreme Court, and what does it involve?
Click here for full article

January 9, 2015

Employers applaud employer mandate bill

The Republican-led House of Representatives didn’t waste any time smashing a symbolic hole in the Patient Protection and Affordable Care Act. This week, the House approved a bill that would redefine a full work week for purposes of triggering a requirement of PPACA. When the law originally took effect, it defined the full work week for purposes of health coverage as 30 hours. It was among the most contentious elements of the law, and led to the creation of “More Time for Full Time,” an organization of organizations opposed to it. MTFFT members included the U.S. Chamber of Commerce, SHRM, the National Retail Federation, the National Association of Theatre Owners — nine “coalition partners” in all representing untold thousands of employers.

December 8, 2014

2015 PPACA compliance checklist

More Patient Protection and Affordable Care Act group health provisions are supposed to begin taking effect in 2015. The current schedule calls for a transitional version of the PPACA “play or pay” employer coverage mandate to apply to employers with 100 or more full-time employers, and to some employers with 50 to 99 employees.
Click here for full article

December 1, 2014

What 2015 means for PPACA

In many ways, 2014 was a pivotal year for PPACA, as most major reforms came online in the past 11 months. Among the facets implemented were the Health Insurance Tax, subsidies, state and federal exchanges, minimum standards, health care co-ops, Medicaid expansion and new rules for wellness programs, minimum waiting periods and several market reforms. There were lots of problems, and the government tacked on plenty of last-minute changes and extensions in an effort to smooth the implementation. It all resulted in a flood of negative press for PPACA. Public perception has fallen so far that polls now consistently show that around 60 percent of Americans don't favor the law.
Click here for full article

November 11, 2014

Department of Labor Confirms That Employers May Not Pay for Employees in Exchanges on a PreTax or Post-Tax Basis

On November 6, 2014, the Department of Labor (“DOL”) issued FAQ Part 22 (FAQs about Affordable Care Act Implementation (Part XXII))1. This FAQ directly addressed the efforts by some employers to reimburse employees for participation in the Marketplace / Exchange through a Code Section 105 (HRA) arrangement, or through some other type of arrangement. The recent FAQ, coupled with the prior guidance on the topic2, makes clear that such arrangements will not be permitted on a pretax or post-tax basis. The following is a summary of the newest guidance:
Click here for full article

November 10, 2014

Bill would ease employer mandate rules

The Diane Black attack on the Patient Protection and Affordable Care Act took another leap forward Monday. U.S. Rep. Black, R-Tenn., introduced a bill in Congress Monday that takes aim at two of Black’s pet peeves about PPACA: its “onerous” reporting requirements, and its subsidies for individuals who apply for health insurance under the law.
Click here for full article

October 6, 2014

Monthly Benefits Update

IRS Issues Guidance on How to Deal With a Change to an Employee’s Measurement Period Under ACA Employer Mandate The Internal Revenue Service (IRS) issued Notice 2014-49, which proposes an approach for dealing with changes to an employee’s look-back measurement method in determining the employee’s full-time status under the Affordable Care Act’s (ACA) “employer mandate.” The new guidance would apply to situations where an employee’s measurement period changes due to the employee’s transfer to a different position or due to the employer’s decision to modify the measurement period for that employee’s classification.
Click here for full article

September 22, 2014

PSI - Health Reform Update

CONGRESS Appeals court rejects claim that employer mandate must immediately be implemented. The Seventh U.S. Circuit Court of Appeals rejected the latest challenge this week to the employer mandate under the Affordable Care Act (ACA). The lawsuit filed by the Association of American Physicians and Surgeon s is similar to the one authorized over the summer by House Republicans (but yet to be filed), as it claims that the Obama Administration lacked the constitutional authority to delay the employer mandate past the January 1, 2014 implementation date set by the ACA and must immediately do so (see Update for Week of July 28th.

However, the panel of three judges appointed solely by Republican presidents found that the plaintiffs lacked standing to bring the claim since they could not show they suffered any direct harm from the delay
Click here for full article

August 6, 2014

Play or Pay in 2015 — so many requirements, so little time

2015 is getting close and the Employer Shared Responsibility Mandate (“Play or Pay”) under the Affordable Care Act (ACA) is almost here. So what does this mean for your organization? Play or Pay requires certain employers to offer affordable and adequate health insurance to full-time employees and their dependents, or they may be liable for a penalty for any month coverage is not offered.
Click here for full article

May 22, 2014

ACA compliance: Why employers can’t game the system on employee hours

Whenever the U.S. Congress draws a line in the sand — such as with exposure for assessable payments under the Affordable Care Act’s employer shared responsibility rules — entities subject to regulation (here, applicable large employers) will inevitably seek ways to avoid having to comply. Also inevitably, some compliance strategies will be perfectly legitimate, while others will not be. One approach that falls into the latter category involves capping annual hours of certain, “variable hour” and other employees at 1,560 hours. Simply put, the approach does not work. This post explains why.
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March 28, 2014

How Compensation Impacts ‘Play or Pay’ Decisions

Many big retailers including Target, Home Depot and Wal-Mart recently announced moves to drop health benefits for their part-time employees, claiming the move is better for workers now eligible to receive federal subsidies or tax credits under the Affordable Care Act (ACA) for policies purchased through a public insurance exchange.

With every passing day, more of the nation’s employers move closer to facing their own “play or pay” decisions—whether or not they will offer health benefits or (if they employ 50 or more full-time employees or part-time equivalents) pay a penalty instead. Many major provisions of the ACA have been phased in as of January 2014, while the remaining provisions are expected to take effect by 2020.
Click here for full article

February 28, 2014

Long-awaited final employer "pay or play" regulations issued

The Internal Revenue Service (IRS) and Department of the Treasury (Treasury) have issued long-awaited final regulations on the employer "pay or play" health care mandate. Although the final employer mandate regulations offer some transitional guidance for certain employers, many employers should take action now to ensure that they comply with the employer mandate when it becomes effective in 2015.

One of the key requirements of the Patient Protection and Affordable Care Act, as amended (the "Affordable Care Act") is the new employer shared responsibility or "pay or play" mandate. The employer mandate requires most large employers (generally those with 50 or more employees) to offer full-time employees and their dependent children qualifying health insurance coverage or pay a monthly penalty to the federal government. The IRS and Treasury issued proposed regulations on the employer mandate in December 2012. Recently, after receiving numerous public comments, the IRS and Treasury issued longawaited final regulations on the employer mandate, as well as a fact sheet and questions and answers on the employer mandate.
Click here for full article

February 10, 2014

Final Employer Mandate Rules Released

On February 10, 2014, The United States Treasury Department issued the Final Regulations implementing Employer Shared Responsibility Under the Affordable Care Act (ACA) for 2015. This component of ACA is more popularly known as the Employer Mandate or the Pay or Play provision. Basically, this is the section of Health Care Reform that requires certain employers offer certain employees medical coverage or face a penalty.
Click here for full article

February 10, 2014

Employer mandate delayed again

(Bloomberg) -- Employers with fewer than 100 workers won’t have to provide health insurance until 2016 under Obamacare, as the administration said it would again delay a key requirement of the health law.
Larger firms have to cover at least 70 percent of the workforce starting next year, the Internal Revenue Service said in a rule issued today.

The Patient Protection and Affordable Care Act envisioned as a cornerstone of its expansion of U.S. insurance coverage that employers with 50 or more workers would be required to provide health benefits to their employees. Under pressure from business groups, the Obama administration has weakened that requirement since July, first by delaying enforcement of the mandate until 2015. Many firms will have even more time under the regulation issued today.
Click here for full article

January 15, 2014

Prepare for 2015's play-or-pay penalties today: 3 places to start

Employers should already be focusing on getting ready for 2015 and it’s an adviser’s job to tell them this. The play-or-pay penalties will be enforced next January. Benefits lawyer Peter Marathas, of the firm Proskauer Rose and its Health Care Reform Task Force team, says there are three areas advisers need to sit down to prepare their clients for today.
Click here for full article

November 8, 2013

ACA mandates delayed, but reporting requirements are crucial

The Internal Revenue Service has issued proposed regulations on reporting requirements under the Affordable Care Act. The regulations, released on Sept. 9, address two separate ACA reporting requirements: one relating to the individual mandate and the other relating to the employer mandate. Failure to comply could result in tax penalties unless the failure is due to reasonable cause and not willful neglect. Each of these requirements has been delayed one year. The government is encouraging voluntary compliance for reports due in 2015 (for the 2014 calendar year), but the first mandatory reports are not due until 2016 (for the 2015 calendar year).
Click here for full article

October 31, 2013

The ACA’s Employer Mandate Explained: Alliance for Health Reform Toolkit

Beginning in 2015, most large employers will have to offer health insurance to their employees or face a fine. The “employer mandate,” as it is known, applies to organizations with more than 50 full-time employees, defined as employees who work 30 hours per week or more. The Alliance for Health Reform has released a new toolkit outlining key facts, data, and resources about the ACA’s employer mandate. If you’re an employer with more than 50 full-time employees, here are three important facts that you need to know:
Click here for full article

September 10, 2013

Obamacare update: What delaying the employer mandate means for businesses

The delay in a key Obamacare provision has created plenty of uncertainty for American businesses. The Obama Administration signed the Affordable Care Act (ACA) into effect in 2010. A significant part of that legislation includes the employer mandate which requires businesses with more than 50 employees to offer insurance to employees working a minimum of 30 hours as of January 1, 2014. In addition, that coverage must be deemed “affordable and adequate coverage” as defined by the legislation.
Click here for full article

September 9, 2013

Employer penalties for not offering coverage or providing unaffordable coverage to full-time employees

Certain employers are subject to the employer responsibility provision under the ACA. Under this provision, such employers may be penalized for (1) not providing minimum essential coverage to their full-time employees and dependents, or (2) not providing coverage that is affordable and that provides minimum value. On January 2, 2013, a proposed rule was published (subject to a comment period). When does the employer responsibility provision take effect? It is effective beginning January 1, 2014. However, the regulators have announced transitional relief for the first year. This provision will not be enforced until 2015.
Click here for full article

August 2, 2013

The Economics of 'Pay-or-Play' Mandates

With over 46 million non-elderly Americans currently lacking health insurance coverage, many policy makers are calling for reforms to reduce the ranks of the uninsured. One popular option is the "pay-or-play" mandate, in which employers are required to either provide health insurance for their employees or pay a penalty to offset costs the government incurs to provide health care for the uninsured. Massachusetts' recently enacted health care reform includes a small financial penalty for employers who do not provide insurance, while other states such as California are contemplating larger penalties.

Proponents of these mandates argue that they could significantly reduce the ranks of the uninsured, since the vast majority of the unin-sured-over 70 percent, according to a recent Kaiser Family Foundation study-are in families with at least one full-time worker. Many of these are low-income families, suggesting that mandates may be a useful mechanism for providing insurance for the working poor.
Click here for full article

July 15, 2013

HealthCare Reform Legislative Brief – Employer Mandate Delayed until 2015

The Obama Administration has postponed the Affordable Care Act (ACA) employer mandate penalties for one year, until 2015. The Department of the Treasury announced the delay on July 2, 2013, along with a similar delay for information reporting by employers, health insurance issuers and self-funded plan sponsors. The delay does not affect any other provision of the ACA, including individuals’ access to premium tax credits for coverage through an Exchange. The Treasury plans to issue more formal information about the delay within a week.
Click here for full article

July 5, 2013

Pay or Play and Information Reporting Mandates Delayed Until January 1, 2015

This Health Care Reform Bulletin applies to employers with more than 50 employees. By way of a blog post on Tuesday evening1, the Treasury announced a one year delay for mandatory employer reporting requirements. As a result of the delay the employer shared responsibility mandate (Pay or Play) will also be delayed, moving the effective date from January 1, 2014 to January 1, 2015. This means applicable large employers will not be required to offer health coverage to all full-time employees and their dependents or be subject to a penalty beginning next
Click here for full article

July 3, 2013

Health Care Law's Employer Mandate Delayed Until January 2015

The Obama administration caught the U.S. business community by surprise when it announced a one-year delay, until Jan. 1, 2015, in the Patient Protection and Affordable Care Act (PPACA or ACA) mandate that employers with 50 or more full-time-equivalent employees provide health care coverage to their full-time employees (those working on average 30 or more hours per week) or pay steep penalties.

The announcement, by Mark J. Mazur, the assistant secretary for tax policy at the U.S. Treasury Department, was made via the Treasury Notes blog late in the day on July 2, 2013. Mazur said the mandate's delay is intended to "provide time to adapt health coverage and reporting systems while employers are moving toward making health coverage affordable and accessible for their employees." He added: "During this 2014 transition period we strongly encourage employers to maintain or expand health coverage. Also, our actions today do not affect employees’ access to the premium tax credits available under the ACA (nor any other provision of the ACA)."
Click here for full article

June 10, 2013

Employer Play Or Pay Penalty Is Almost In Effect. Are You Ready?

Beginning in 2014, if you are an "applicable large employer" you may be subject to a tax penalty under the Patient Protection and Affordable Care Act (the "ACA") if you do not offer group health care coverage to a sufficient number of your full-time employees (and their dependents) or if the coverage is not "affordable" or does not provide "minimum value." This tax penalty is commonly referred to as the "play or pay" penalty or the penalty under the "employer shared responsibility" provisions of the ACA.

This article provides an overview of (i) the "play or pay" penalty, (ii) the key rules for determining whether you are an "applicable large employer" and (iii) if you are an "applicable large employer," which employees would be considered full-time employees to whom coverage must be offered to avoid the play or pay penalty.
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April 22, 2013

The Affordable Care Act’s “Play

Recently, we published a Client Update explaining how the Play-or-Pay mandate, or Employer Shared Responsibility provision, under the Affordable Care Act (ACA) generally works. To summarize, we described how an employer counts its full-time employees, including full-time equivalent employees, solely for purposes of determining whether the employer is an “applicable large employer” subject to the Play-or-Pay mandate.

We also explained that an applicable large employer becomes subject to an Employer Shared Responsibility Payment (the penalty tax) if (1) it fails to offer the opportunity to enroll in an employer-sponsored health plan that offers minimum essential coverage to substantially all full-time employees (and certain dependents); or (2) minimum essential coverage is offered to all of its full-time employees (and certain dependents) but it is unaffordable or does not provide minimum value; and (3) at least one of the applicable large employer’s full-time employees receives a premium tax credit or cost-sharing eduction for purchasing health insurance through an Exchange. Finally, we covered how to calculate the penalty taxes to which such an applicable large employer would be subject
Click here for full article

March 7, 2013

IRS Issues Healthcare “Pay or Play” Mandate

The Department of Treasury and Internal Revenue Service have issued regulations on the Affordable Care Act’s employer shared responsibility provisions, also known as the “Play or Pay” mandate. Starting in January 2014, the mandate requires large employers (generally those with 50 or more full-time employees, including full-time equivalent employees) to either “play” by offering affordable health coverage to their full-time employees and their dependents, or “pay” a penalty if the employer fails to provide affordable health coverage and at least one full-time employee receives a premium tax credit to help purchase coverage through an Insurance Exchange.

For New Jersey, the Exchange will be run by the federal government. Open enrollment for 2014 is scheduled for October, 2013. Employers will need to notify their employees beforehand. The Play or Pay mandate applies to all large common law employers, including tax exempt entities and government entities (such as Federal, State, local or Indian tribal government entities). However, for purposes of determining applicable large employer status, and for penalty purposes, hours worked outside of the United States are disregarded, provided that the associated compensation constitutes foreign source income.

In general, there are two potential penalties (both non-deductible for tax purposes) that could be imposed on an employer for failure to satisfy the mandate. The first penalty, known as the “no coverage” penalty, is based on whether an employer fails to offer group health plan coverage to its full-time employees and their dependents. In this case, the annual penalty is $2,000 per full-time employee (minus 30 full-time employees) if at least one employee receives a premium tax credit for Exchange coverage.
Click here for full article

March 1, 2013

The Mandate and Beyond

Health care reform requires executives to make decisions based on incomplete information. With 30 employees in Los Angeles and Seattle, Coalition Technologies, a web design and marketing company, isn’t large enough to be subject to the health coverage mandate under the Patient Protection and Affordable Care Act. Yet this year Chief Executive Officer Joel Gross is planning to offer health insurance coverage for the first time. Still, he has concerns. “With the federal government and states mandating that I cover a wide range of benefits, it may be difficult in the future to keep up with the requirements,” he says. He expects that most federal subsidies and tax credits available to certain small employers will be gone after three years. He counts on maintaining strong corporate growth to cover these costs.
Click here for full article

February 4, 2013

SHRM: Making the “Play or Pay” Decision

As the key provisions of health care reform under the Patient Protection and Affordable Care Act (PPACA) move closer to implementation, employers need to consider how they will respond. More specifically, employers with 50 or more full-time equivalent employees need to decide whether they will “play” by continuing or beginning to offer affordable health benefits to employees working an average of 30 hours or more per week in a month, or “pay” the penalties for not offering affordable benefits.
Click here for full article

February 1, 2013

Come Out and Play

Multiple surveys show the majority of employers will opt to play - maintaining health benefits - rather than pay PPACA fines

“One percent."

"I would be surprised if we see many, if any."

According to most experts, the number is small. Not only is it small, it keeps getting smaller. We speak, of course, of the number of companies with 50 or more employees that will drop employer-sponsored insurance in 2014 - opting to send employees to state-run insurance exchanges and pay per-employee fines levied by the Patient Protection and Affordable Care Act. After a McKinsey & Company study in 2011 famously concluded that 30% of employers would "pay" rather than "play," survey after survey has revealed that fewer than 5% of employers plan to eliminate employee health benefits. Even the Government Accountability Office, which originally reported as much as 20% of employers would drop coverage, now has backed off to around 2%.
Click here for full article

January 15, 2013

PPACA: Play or Pay? 7 Reasons Why “Pay” is Not the Easy Answer

With every day that goes by, the nation’s employers move a step closer to having to make a decision: Do I play or pay? Employers now have just a little more than one year to prepare themselves and their workforces for the arrival of the core of the Patient Protection and Affordable Care Act, which requires employers with 50 or more full-time employees to offer medical coverage or pay a penalty. Although a year might seem like ample time, the decision isn’t an easy one, and it’s fraught with financial, legal and competitive implications.
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January 1, 2013

IRS Posts PPACA Employer Mandate Draft

The Internal Revenue Service (IRS) is trying to prevent employers from getting around the new "play or pay" health benefits rules by reclassifying full-time workers as something else. The IRS talk about methods for classifying specific types of workers, such as teachers, airline pilots and rehired workers, in the preamble to draft regulations for implementing the "shared responsibility" parts of the Patient Protection and Affordable Care Act (PPACA).
Click here for full article

There are a number of webinars and seminars to help you stay ahead of Health Care Reform from a national and state-wide level. These sessions help educate and provide valuable insight to employers and professionals on the Patient Protection and Affordable Care Act. BSI Corporate Benefits provides access to these valuable training opportunities to all clients at no cost.

Webinars/Seminars - Health Care Reform News:

October 7, 2015

Employer Sponsored Group Health Plans & ERISA

Employer Sponsored Group Health Plans & ERISA ( Employee Retirement Security Act) …. Employer ERISA Responsibilities and Risk 1. Which Group health and welfare benefit plans are subject to ERISA? 2. What does an employer have to do to be compliant? 3. What documents are required – what Records does an employer need to keep on file? 4. What forms need to be filed & what should my employees receive? 5. Employer risk for ERISA noncompliance 6. How does an employer determine if they are complaint with ERISA and the Affordable Care Act?
Click here for full article

October 5, 2015

2015 SHRMLV October Conference - Take Me out to the Ball Game: Covering Your HR Bases

This year's Conference will include the many disciplines within HR including Health Care Reform Compliance.
Click here for full article

September 30, 2015

Upcoming Reinsurance Assessment Fee Webinars

The Centers for Medicare and Medicaid Services will host three free webinars in September explaining how to complete and submit the 2015 ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form and providing information about how to pay the fee. The form is expected to be made available atpay.gov/public/home on Oct. 1, 2015. Staff who are completing the form for employers with self-insured group plans may want to consider attending one of the training sessions.
Click here for full article

September 16, 2015

ACA 6055 & 6056 Reporting- Understand the who, what and when

All employers must comply with new reporting requirements under the Affordable Care Act for the period beginning in 2015. Join us for this webinar to learn more.
Click here for full article

September 1, 2015

SHRM: Implementing Affordable Care Act Reporting

Under the Affordable Care Act, employers with 50 or more full-time employees have a new set of tax information reporting obligations they must meet for tax year 2015, per Internal Revenue Code 6055 and 6056 guidelines. For many organizations, responsibility for this reporting falls on HR and benefits departments. In this program, Ray Grove of Sovos Compliance will provide an overview of the new reporting obligations and discuss common challenges employers will face in implementing this new reporting process - See more at: http://www.shrm.org/multimedia/webcasts/pages/default.aspx#sthash.0IRvul47.dpuf
Click here for full article

July 8, 2015

ACA After the Supreme Court: Compliance Requirements and Strategies

In June 2015, the Supreme Court issued a key ruling upholding the health reform law. Specifically, the Court held that federal subsidies can be provided in states that did not set up their own exchanges. That leaves intact the employer mandate and its related penalties. Now that the law is here to stay, with changes by Congress highly unlikely, what does this mean for the employers? In this program Sibyl Bogardus, Chief Compliance Officer at Hub International, will discuss employer obligations post-Supreme Court ruling: - See more at: http://www.shrm.org/multimedia/webcasts/pages/0715bogardus.aspx#sthash.33xQMJRZ.dpuf
Click here for full article

July 22, 2015

BASIC FMLA Administration - Demo of BASIC's FMLA Dashboard and Administration

Join us for a brief overview of BASIC’s FMLA Administration. Employer Solutions Specialist, Kaitlin VanTuinen, will highlight the DOL identified common employer mistakes. BASIC’s Regional Director, Marisha Taylor, will demonstrate our proprietary 24/7 Dashboard. This is your chance to ask questions regarding our multi-step claims verification process and learn about our different service levels.
Click here for full details

July 13, 2015

Advanced COBRA Regulations

This presentation will cover an in-depth look at current COBRA regulations to ensure employer compliance. Specific topics covered include:

  • What is COBRA & Gross Misconduct?
  • Covered Employees COBRA Rights
  • COBRA Notices must contain and when to send them
  • COBRA Coverage Benefits
  • FSA’s & HRA’s under COBRA
  • Employee and Employer responsibilities
  • Medicare and COBRA coverage
  • COBRA Election Rights for Beneficiaries

  • Click here for full details

    May 30, 2015

    Get Ready – Two Distinct Sets of PPACA Reporting Requirements

    The presentation included a review of the data, critical steps, and dates by which employers need to act for compliance; discussion of the most recent updates; and an overview of Cigna's support. Our insights and discussion helped to simplify these complex reporting requirements and clarify the distinctly different steps for insurers and employers – small vs. large and fully insured vs. self-funded.
    Click here for full details

    April 29, 2015

    Cadillac Tax Under Code Section 4980I

    IRS Notice 2015-16 provides detailed agency proposals for implementing health care reform’s 40% excise tax on high-cost health coverage. Whether you are a health plan sponsor, advisor, or service provider assessing Cadillac tax exposure, join our experts in this 90-minute web seminar as they break down the proposals and help you prepare for compliance.
    Click here for full details

    March 19, 2015

    Line-by-Line Analysis for Employers and Advisors

    Finalized IRS Forms 1094 and 1095 provide a critical roadmap for employers and insurers required to report 2015 health coverage on mandatory filings in early 2016. Although the IRS will rely on the filings to enforce employer shared responsibility (along with the individual mandate and tax credit eligibility), misconceptions still abound regarding who must file and what information must be included. Whether you are an employer or advisor, join our experts in this special 2-hour seminar for line-by-line analysis and explanatory background.
    Click here for full details

    March 18, 2015

    6055 and 6056 Reporting: Are You Ready for the New ACA Employer Reporting Requirements?

    All employers must comply with new reporting requirements under the Affordable Care Act for the period beginning in 2015.

    Topics Include:

    • Details concerning the 2 new different types of reporting and which individuals are required to receive the information
    • A breakdown of the rules depending on the employer’s size and whether the employer’s health plan is fully-insured or self-funded
    • A summary of the information which must be collected to satisfy the new reporting rules
    • An explanation of some simplified reporting methods which are available under the guidance
    • The procedures and timetable for reporting to the IRS and notifying responsible individuals and full-time employees
    Click here for full details

    February 12, 2015

    Uncovering Benefits Compliance Responsibilities in 2015 – What You May Mot Be Prepared For

    Register to learn more about the array of Health Care Reform and ERISA requirements that await many employers in 2015. This presentation will expose the most common myths associated with Health Care Reform and benefits compliance in 2015, and reveal the procedures that employers should be following.
    Click here for full details

    January 6, 2014

    Understanding Health Care Reform For Small Employers

    Navigating the world of Healthcare Reform is challenging at best. The ever changing mandates for employers to remain compliant can be extremely difficult to keep up with. This program provides some insightful information and best practices to for small employers.
    Click here for full details

    October 27 - 28, 2014

    Annual SHRMLV Conference

    Save the Date for the Annual SHRMLV Chapter October 2014 Conference. BSI Corporate Benefits', Anthony DaRe will be a speaker during this educational conference.
    Click here for full details

    October 23, 2014

    The Chamber's Annual Healthcare Summit

    The Chamber's Small Business Council & Healthcare Legislative Committee Presents:
    The Annual Healthcare Summit
    This event is for ALL businesses
    Click here for full details

    October 8, 2014

    2014 HealthCare Symposium

    Join us on October 8 for an informative update on the ever-changing world of healthcare. Industry experts are coming together to speak about the future of the healthcare industry.
    Click here for full details

    October 2, 2014

    BSI 2014 C-Suite Healthcare Summit

    BSI Corporate Benefits is a nationally recognized Employee Benefits Agency, locally headquartered in Bethlehem, PA. BSI is hosting an Executive Summit to discuss the rising costs of health care and strategic options that will save your company hundreds of thousands of dollars.

    Network with fellow Executives, ensure you are health care reform compliant and leave with the tools to take control of your company’s health care spend.
    Click here for full details

    June 22 - 25, 2014

    SHRM 2014 Annual Conference & Exposition

    Our comprehensive program is designed to give you the full range of an HR education, from the basics that every HR professional needs to the innovative ideas that are changing how you work.

    Our 200+ concurrent sessions are organization into the following tracks:
    Click here for full details

    May 14, 2014

    Design and Administration Under Health Care Reform

    Just-released final rules on health care reform’s restrictions on waiting periods (first effective for 2014 plan years) are focusing attention on health plan enrollment provisions, which determine when eligible individuals can begin plan coverage. Whether you sponsor, advise, or administer employer health plans, join our experts as they explain the new waiting period rules, address existing special enrollment requirements (which remain fully effective under health care reform), and more.
    Click here for full details

    April 2, 2014

    Health Care Reform:

    When the "Employer Mandate" provision of the Patient Protection and Affordable Care Act (PPACA) takes effect in 2015, employers with 100 or more full-time employees or full-time equivalents must offer medical coverage that is "affordable" and provides "minimum value" to full-time employees and their children up to age 26, or they may face penalties. This same rule will apply to employers with 50 or more employees in 2016.
    Click here for full details

    April 2, 2014

    Health Care Reform Update Webinar

    DATE: Wednesday, April 2, 2014
    TIME: 2:00 PM – 3:30 PM EDT
    1:00 PM – 2:30 PM CDT
    11:00 AM – 12:30 PM Arizona

    Space is limited. Reserve your “Healthcare Reform Update” webinar seat today!

    The Obama administration has given certain employers extra time before must offer health insurance to almost all their full-time workers.

    What will be covered:

    • Employer Mandate – understanding the delay
    • Detailed information on the 90 day waiting period

    Larry will present for 60 minutes regarding the above topic. The remainder of the time will be devoted to Q&A and information regarding BASIC’s Administration services.
    Click here for full details

    February 12, 2014

    Compliance Webinar: Preparing for 2015: The Employer Mandate

    The Employer Mandate, also known as Pay or Play, becomes effective January 1, 2015. While everyone still eargerly awaits the release of the final regulations, there are steps that employers should be taking now to put them in the best possible position on January 1, 2015. Please join us as we discuss the mandate's requirements, the penalties, how to determine if you are subject to the mandate as well as how to count and classify part-time employees.

    Title: Preparing for 2015: The Employer Mandate
    Date: Wednesday, February 12, 2014
    Time: 10:00 AM - 11:30 AM EST
    Click here for full details

    February 11, 2014

    1.5 HRCI – Healthcare Reform: Preparing for 2015

    Healthcare Reform: Preparing for 2015
    What will be important and any changes that will be effective for 2015:

    • Employer Mandate
    • Determination of a large employer
    • Providing minimum coverage

    Presented by Larry Grudzien, JD, LLM
    Larry has 28 years of experience as an attorney, practicing exclusively in the field of employee benefits.
    Click here for full details

    January 14, 2014

    Ask The HealthCare Experts - SRHMLV

    Starring our Healthcare Panel of Experts: Anthony DaRe, BSI Corporate Benefits Kimberly Nash, Brown & Brown Elizabeth Patterson, Charon Planning Have a question about the PPACA (Affordable Care Act)? There are hundreds of PPACA questions circulating throughout organizations. This is your time to ask those questions! In preparation for our Ask the Healthcare Experts Panel, we are asking you to send us your Affordable Care Act questions. We will not disclose your name when asking the question. As such, this is the best time to ask that question you’ve been too nervous or bashful to ask in front of your peers.
    Click here for full details

    November 19, 2013

    Patient Empowerment in a Post-Health Care Reform World

    ConnectCare3's LaRue McManus and The Benecon Group's Dave Vassilaros will be presenting on the topic, "Patient Empowerment in a Post-Health Care Reform World" at the Capital Blue Store in Lehigh Valley on November 19, 2013 from 12:00 - 1:00 pm. The presentation will be about 45 minutes, followed by a Q&A session. Capital BlueCross will provide a catered lunch.
    Click here for full details

    November 11, 2013

    FSA Use-It-or-Lose-It-Rule Modified & Other ACA Changes to Cafeteria Plans

    The Department of Treasury issued Notice 2013.71 that modifies the FSA “use-it-or-lose-it” provision. Effective immediately, employers that offer FSA programs that do not have the “Extended Grace Period” (where expense that are incurred thru March 15 can be paid from prior year’s funds) will have the option of allowing employees to roll over up to $500 of unused funds at the end of the current 2013 plan year. Effective in plan year 2014, employers that offer FSA programs will have the option of allowing participants to roll over up to $500 of unused funds at the end of the plan year.

    We will also cover other ACA changes to Cafeteria Plans:

    • Explanation of allowable pre-tax premiums for medical coverage
    • Stand-alone Health FSA provisions
    • How to handle Individual Premiums

    Click here for full details

    November 8, 2013

    "T-Minus One: A final check for PPACA Launch.”

    Let our host David Vassilaros, Director of Health Care Reform and Regulatory Affairs, and other experts from Capital BlueCross, help you make sure your benefits programs are prime for launch in 2014.
    Click here for full details

    October 28, 2013

    Exchanges: A Review of What They Are and How They Work

    FREE WEBINAR: Exchanges: A Review of what they are are how they work
    DATE: Monday, October 28, 2013
    TIME: 2:00 – 3:30 PM EDT
    1:00 – 2:30 PM CDT
    11:00 AM – 12:30 PM Arizona
    Space is limited. Reserve your “Exchanges” webinar seat now!

    Health care reform requires each state to establish an American Health Benefit Exchange (Exchange), also known as a Marketplace, by Jan. 1, 2014.
    Click here for full details

    October 9, 2013

    Health Symposium 2013

    Industry experts are coming together to speak about the future of the healtcare industry. Topics will include: how the healthcare exchange will work and an update from hospitals.
    Join us on October 9 in conjunction with the LVB Expo for an informative discussion about the future of the healthcare industry. Topics will include how the healthcare exchange will work and an update from hospitals. Reserve your seat today!
    Check back soon for the full list of speakers and an updated agenda.
    Read more: http://www.lvb.com/section/health-care-symposium#ixzz2apjDdBwx
    Click here for full details

    October 7 & 8, 2013

    HR’s Crystal Ball - Predicting the Future by Creating it Today

    SHRMLV's Annual October Conference
    October 7th and 8th at the Best Western, Bethlehem
    Approved for 11 credit hours through HRCI - including 3 strategic
    HR's Crystal Ball - Predicting the Future by Creating it Today
    Join us for two power packed days!
    Click here for full details

    October 4, 2013

    “Houston, We have A Problem: Contingency Planning for PPACA Implementation.”

    Let our host David Vassilaros, Director of Health Care Reform and Regulatory Affairs, and other experts from Capital BlueCross, help you make sure your benefits programs are prime for launch in 2014.
    Click here for full details

    September 26, 2013

    The Affordable Care Act (ACA) - Are You Ready?

    The 2013 Health Care Summit presented by the Greater Lehigh Valley Chamber’s Small Business Council and Healthcare Legislative Committee on Thursday, September 26, 2013 at DeSales University Center.
    Registration begins at 11:00 a.m.
    Audience: Approximately 200 Lehigh Valley business leaders and health care professionals. - See more at: http://www.lehighvalleychamber.org
    Click here for full details

    September 13, 2013

    “The Final Countdown to ACA”

    The Chamber Small Business Council and Healthcare Legislative Committee present “The Final Countdown to ACA” on Friday, September 13, 2013 at DeSales University, from 7:30 to 9:30 AM.
    The BIG DAY in health insurance is January 1, 2014, when much of the Affordable Care Act will be enforced.
    What information about ACA implementation is now available?
    What decisions do Small Businesses need to make?
    What are the “exchanges”? Should you just send your employees there?
    Should you bother with this at all?
    Click here for full details

    August 9, 2013

    “Preparing the Launch Site: How to have a Successful Implementation.”

    Let our host David Vassilaros, Director of Health Care Reform and Regulatory Affairs, and other experts from Capital BlueCross, help you make sure your benefits programs are prime for launch in 2014.
    Click here for full details

    August 9, 2013

    LVBCH Roundtable

    This exclusive event will provide you with an update on the Patient Protection and Affordable Care Act (PPACA) and what's next for employers. This is an excellent opportunity for you to engage in a lively discussion with our expert panelists and to get your important questions answered. Additional information about the event is presented below.
    Click here for full details

    July 16, 2013

    Health Care Reform - Common Compliance Questions

    Larry Grudzien will cover 21 of the most common questions he receives from agents and employers across the country.

    1. Which employers are subject to the employer mandate in 2014?
    2. If my employer is a large employer and sponsors a health plan with a non-calendar plan year, when does it have to comply with the employer mandate?
    3. How does employer determine if it’s a large employer for employer mandate purposes?
    4. In determining whether an employer is a large employer for employer mandate purposes when do we have to consider other businesses owned by the employer in to total?
    5. Does an employer have to offer health coverage to the employee’s children or spouse?

    Presented by Larry Grudzien, JD, LLM
    Larry has 28 years of experience as an attorney, practicing exclusively in the field of employee benefits.
    Click here for full details

    June 27, 2013

    Health Care Reform: What's Next?

    Aetna Streaming Media The following audio presentations will provide you with important updates concerning the implementation of the Affordable Care Act (ACA), as well as our perspective on how recent developments may affect you.
    Click here for full details

    June 7, 2013

    Halfway to Launch: Assessing Your Preparation for PPACA.”

    With a little less than six months left before the launch of many the provisions in the PPACA, is your company ready? Find out where you stand by attending our (Capital Blue Cross) Webinar.
    Click here for full article

    May 22, 2013

    Executive Briefing: Employer Responsibility Requirements for Health Care Reform

    Implementing the Affordable Care Act is no small task for employers. In this complimentary executive briefing we’ll cover the employer responsibility requirements that take effect in 2014 and discuss what employers must do to comply.

    Join executives from ADP, Crowe Horwath and Warner Norcross & Judd as they cover:

    • What are the most important aspects of the Affordable Care Act?
    • Who is subject to pay-or-play penalties?
    • Which employers (including temporary or seasonal ones) must be offered coverage?
    • Is the coverage you’re offering affordable?
    • What are the minimum-value requirements for employer-sponsored coverage?

    Featured Speakers

    • Norbert Kugele, Attorney
    • Partner with Warner Norcross & Judd
    • Amy Mackey, PHR
    • Senior Solutions Consultant with ADP
    • David Horvath, CPA
    • Director with Crowe Horwath

    Click here for full details

    May 15, 2013

    Health Care Reform - Blue Zone: Presented by Capital Blue Cross

    Blue Zones – as discovered by internationally-recognized researcher, explorer, New York Times bestselling author, and National Geographic Fellow, Dan Buettner - are five communities located throughout the world having the highest proportions of people who live to 100 years of age and do so in excellent health. Through extensive research and study, Buettner and his team discovered nine common characteristics found in Blue Zones that are believed to contribute to long life and vitality.

    Please join Capital BlueCross as Dan Buettner shares the secrets of the Blue Zones and explains how the concepts can be applied to your personal and work environments. Also hear how local businesses and communities are applying the Blue Zones concepts to promote a stronger workforce, healthier bottom-line and tighter-knit communities.
    Click here for full details

    May 8, 2013

    Health Care Reform: What's Next? - Large Group Plan Sponsors

    Please join members of Aetna’s leadership team for an update on the Affordable Care Act (ACA) and the path forward to foster both compliance and readiness.

    The ACA turned three years old in March 2013. The law has already had enormous impact on our business and has made significant changes in the benefits and care that consumers are receiving today, but that was just the tip of the iceberg.

    In 2014, we will experience tremendous change as many of the law’s most significant provisions go into effect. To help you understand these impactful provisions, Aetna has created a new webinar: Health Care Reform: What’s Next? An audio recording of this webinar and copy of the presentation deck will be available on Aetna’s Health Reform Connection site by early June.

    During this webinar, you will learn about:

    • Basic health care consumption, increased premiums and waste in the system
    • How the health care landscape is changing and what you can do to prepare for what’s next
    • Public and private exchanges
    • Maximizing your benefit strategy in the “new” world and more

    This webinar will be facilitated by Jay Sheehy, Chief Underwriting Officer and Head of Aetna’s Health Care Reform Project Management Office (PMO.) Jay will be joined by other leaders from the company who focus on various aspects of the ACA 2014 implementation.

    The ACA impacts us all. We hope that you make the most of this opportunity to learn more about the evolving landscape during this 60-minute webinar.
    Click here for full details

    May 7, 2013

    Employer Mandate Webinar - by Basic

    Webinar Registration

    From an employer’s perspective, this is most likely the most feared aspect of Health Care Reform. In fact, the overwhelming majority of our Health Care Reform-related questions to date in 2013 have covered this topic.

    The “Employer Mandate” is the provision in the Patient Protection and Affordable Care Act (PPACA) that requires “large” employers to provide health insurance to their full-time employees (those working 30 or more hours per week) or face a penalty. A “large” employer is defined as one that has an average of 50 or more “full time equivalent” employees.

    During our webinar we will be covering:

    • Important dates and deadlines
    • How to measure full-time status
    • "Minimum essential coverage"
    • Safe harbor in place for 2014

    Presented by Larry Grudzien, JD, LLM
    Larry has 28 years of experience as an attorney, practicing exclusively in the field of employee benefits.
    Click here for full details

    April 18, 2013

    The ins and outs of play or pay: Employer and individual mandates

    The shared responsibility rules for individuals and large employers become effective on Jan. 1, 2014, and will directly impact the choices that you/your organization makes about whether to purchase or provide health coverage, what level of coverage to obtain, and how to share the cost of such coverage. During this webinar our experts will give a timeline of past and future events associated with Patient Protection and Affordable Care Act (PPACA) as well as explain the shared responsibility rules, aka play-or-pay mandates at the employer and individual levels. They will also review the penalties at the employer and individual levels associated with non-compliance and designed based safe-harbors to assure compliance. At the conclusion of this webinar, participants will: Know what is required for employers and individuals beginning in 2014 Be able to identify the general guidelines for determination of large employer status and therefore the applicability of the employer shared responsibility/play-or-pay rules Be able to explain the requirements necessary to avoid or minimize penalties associated with non-compliance for a large employer.
    Click here for full details

    April 9, 2013

    Health Care Reform Connect

    Health Care Reform Conference
    What to know, What to do and Essential Tools This conference is critical for any business or trusted advisor preparing for the immediate rules related to Health Care Reform. Tax penalties, credits, Full Time Employee status and health benefits changes will all be covered. This is a must attend for any business that offers health insurance benefits.
    Click here for full details

    April 3, 2013

    Fast Forward to Health Reform 2014 - UnitedHealthCare

    Join us for an insightful webinar that will cover what is happening with the Health Care Reform landscape in 2014 and what brokers and employers need to know. Topics will include:

    • What are new rules and changes that apply to benefits
    • What effects on premium will occur based on benefit requirements, underwriting changes and fees/taxes
    • How does the Employer Mandate, minimum effective coverage and minimum value affect employers
    • Exchanges and role of reinsurance, risk corridors and risk adjustment
    • What is UnitedHealthcare doing to help customers and brokers prepare for change
    • Where can you go to get updated information

    Our UnitedHealthcare Speakers include:

    • Joy Higa, Vice President, Health Reform Implementation
    • Barry Dehlin, Director of Product Strategy and Planning
    • Tom Gehlbach, Vice President of Underwriting
    Click here for full details

    March 26, 2013

    The Affordable Care Act - The Price of Reform (YORK)

    The Affordable Care Act (ACA) has far reaching cost and coverage implications for all companies regardless of size. Companies of less than 50 employees are not affected by the Act’s “play or pay” penalties but the establishment of the federal healthcare exchanges will influence how and if you provide health insurance into the future.
    Click here for full details

    March 21, 2013

    Health Care Reform - A Conversation (Capital Blue Cross)

    Let's talk health care reform. Let's get real. Real questions. Real answers. Join us in a casual setting and get real answers about the mandates, the coverage changes, the costs, and the anticipated affects of health care reform.
    Thursday, March 21

    • Lunch and learn 12 to 2 p.m.
    • Evening session 5 to 7 p.m.

    Click here for full details

    March 20, 2013

    Hartman's HCR Broker

    Health Care Reform Seminar - "What you need to know: HCR and Compliance for 2013 and Beyond"


    Hollywood Casino - Grantville, PA
    NEXT Wednesday March 20, 2013
    Registration & full breakfast at 8:30AM, Presentation will begin at 9AM
    Presenter: Dave Vassilaros, Capital BlueCross' Director of Health Care Reform


    PLEASE RSVP by noon Friday 3/15 to dawn@hartmangroup1.com so we can get our final headcount!
    If you have any specific topics or questions that are of particular interest that you would like to cover, please send these over in advance to Dawn. There will be time for Q&A after the presentation as well.
    Click here for full details

    March 5, 2013

    Getting Ready to "Pay or Play": What Health Care Reform Requires in 2014

    Neal Gerber Eisenberg:
    Two N. LaSalle Street | Suite 1700 | Chicago, IL 60602
    Effective Jan. 1, 2014, the Affordable Care Act requires large employers to provide affordable health care coverage to their full-time employees or pay a penalty. Likewise, most individuals will be required to have health insurance or pay a penalty. Our seminar on March 5, 2013 will answer the following questions:

    • Which employers are large employers for purposes of this health insurance mandate?
    • What must an employer health care plan cover?
    • Which employees must be offered coverage?
    • How much of employees' health care costs must employers pay?
    • What options are available to help employers and individuals comply with the Affordable Care Act and cope with the rising cost of health insurance?
    Click here for full details

    February 28, 2013

    Affordable Care Act: Action Plan Webinar

    As a follow-up to Bass, Berry & Sims’ previous webinars on the Play or Pay Mandate, the Employee Benefits attorneys at Bass, Berry & Sims will walk through an action plan that employers can use to prepare for and ensure compliance with the Affordable Care Act. In addition, the firm’s Employee Benefits attorneys will provide a refresher and updates on other provisions of the Affordable Care Act that are effective or will become effective in the future.
    Click here for full details

    February 21, 2013

    MMA - Understanding PPACA’S Employer Shared Responsibility Provisions and Penalties

    Some of the most talked about aspects of the Patient Protection and Affordable Care Act ("PPACA") relate to the employer shared responsibility provisions. With the 2014 effective date looming right around the corner, employers must determine whether they are subject to these potential penalties and analyze their current health plans to determine what penalties, if any, they could be facing next year. Determining whether coverage is "affordable" and provides "minimal coverage".
    Click here for full details

    February 14, 2013

    Healthcare Reform Full Time Status: Presented by Basic

    Effective Jan. 1, 2014, employers with 50 or more full-time equivalent employees must offer full-time employees (and their dependents) “affordable” health coverage with a “minimum value,” or face possible penalties.

    During our webinar we will be covering:

    • Important dates and deadlines
    • Who must comply
    • How to measure full-time status
    • Safe Harbors (New hire and ongoing employees)
    • Applicable rules
    • 90 day waiting period

    Click here for full details

    February 7, 2013

    Varnum Health Care Reform Webinar

    This 90 minute live webinar will address what employers should be doing to plan for upcoming changes required under the Affordable Care Act. Varnum Attorneys Nancy Farnam and Kimberly Mitchell will cover the following topics:

    • Employer mandate to offer coverage to full time employees and dependents
      • Employers subject to the employer mandate requirements
      • "Full time" employees
      • Potential penalties
      • Under what circumstances might a penalty tax be assessed
    • Benefit coverage issues
      • Essential health benefits
      • Preventive coverage
      • Limits on cost sharing and deductibles
      • Limits on waiting periods
      • Coverage for clinical trials
    • New reporting and disclosure requirements
      • Summary of benefits and coverage
      • Advance notice of material modifications
      • W-2 reporting
      • Notice of Exchange
      • IRS reporting regarding minimum essential coverage
    • New taxes

    Click here for full details