Healthcare

Monday, 02 February 2015

Claiming the 2014 small business health care tax credit

Written by Thomson Reuters

The IRS has released the 2014 version of Form 8941, which can be used by eligible small employers to calculate the health care tax credit. Created as part of the Affordable Care Act (ACA), this credit generally is available to employers that: Have fewer than 25 employees. Pay average annual wages of less than $50,000 (indexed for inflation; see below.) Contribute a uniform percentage of at least 50% of the premium costs for employee health insurance coverage...

Published in Healthcare
Monday, 02 February 2015

Summary of benefits and coverage requirement to undergo changes

Written by Thomson Reuters

The IRS, Department of Labor (DOL), and Department of Health and Human Services (HHS) have issued separate but largely identical proposed regulations relating to the Affordable Care Act’s (ACA’s) summary of benefits and coverage (SBC) requirement. The agencies have also released proposed revisions to the SBC template, instructions, uniform glossary and other materials. These latest proposed regulations would modify the final regulations issued in 2012. According to the agencies, the proposed changes — which would generally apply to plan years beginning on or after September 1, 2015 — are intended to streamline the SBC requirement to more clearly provide the information most useful to individuals (as indicated by comments from stakeholders) and ease compliance for insurers and group health plans...

Published in Healthcare
Monday, 02 February 2015

Old law, new impact: The mental health benefit parity requirement

Written by Thomson Reuters

The Mental Health Parity and Addiction Equity Act (MHPAEA) has been on the books for years. Yet some employers are about to feel the law's impact for the first time. That's because mental health and addiction services are one of the Affordable Care Act's (ACA's) 10 mandated essential health benefits (EHBs) that small group plans must offer if they fall under the act's purview. Thus, such "nongrandfathered" small group plans that kick in on or after July 1, 2014, must now comply with the MHPAEA...

Published in Healthcare
Monday, 29 December 2014

Wellness programs under fire despite ACA encouragement

Written by Thomson Reuters

The Affordable Care Act (ACA) includes incentives intended to encourage employers to establish formal programs to promote employee wellness. Yet recent legal actions taken by the Equal Employment Opportunity Commission (EEOC) appear to fly in the face of this very encouragement. Employers caught in the crossfire should familiarize themselves with the legal issues in play and be prepared to modify some facets of their programs until the diverging policy objectives are reconciled. ACA background The ACA supports sponsorship of wellness programs by establishing percentage-based reward incentives...

Published in Healthcare

The IRS recently issued Notice 2014-69, which contains an important update on the “minimum value” requirement of the Affordable Care Act’s (ACA’s) shared responsibility, or “play or pay,” provision. Specifically, the agency is working with the Department of Health and Human Services to adopt regulations under which group health plans that exclude substantial coverage for inpatient hospitalization services or physician services (or both) won’t satisfy minimum-value standards. No calculator allowed If large employers (as defined under the ACA) don’t offer their full-time employees affordable, minimum essential coverage that provides at least “minimum value,” they could incur a financial penalty under the play-or-pay provision should just one such employee receive a premium tax credit through a Health Insurance Marketplace. Notice 2014-69 explains that the forthcoming regulations will respond to concerns that nonhospitalization / non–physician-services plans can still satisfy minimum-value requirements using the online calculator on the Centers for Medicare and Medicaid Services website and following one of three alternative methods for demonstrating minimum value...

Published in Healthcare
Monday, 29 December 2014

Would a plan without an annual open enrollment run afoul of play or pay?

Written by Thomson Reuters

Question: Our company sponsors a self-insured group health plan, and historically we haven’t conducted an annual open enrollment period. We have hundreds of employees and are considering compliance with the Affordable Care Act’s (ACA’s) shared-responsibility provision. Would our plan design subject us to penalties? Answer: Because you appear to be a large employer as defined under the ACA — that is, you employ an average of at least 50 full-time employees or the equivalent — your current plan design may indeed put you at risk for penalties under the ACA’s shared-responsibility, or “play or pay,” requirements...

Published in Healthcare
Wednesday, 26 November 2014

Ready, small businesses? Online SHOP enrollment has begun

Written by Thomson Reuters

It began on Nov. 15. That was the date when online enrollment for 2015 coverage through the Small Business Health Options Program (SHOP) went live. As you might recall, online enrollment was delayed in 2013, and small businesses were directed to work with an agent, broker or insurer to complete and submit paper applications for 2014...

Published in Healthcare
Wednesday, 26 November 2014

Finalized regulations on excepted benefits now available

Written by Thomson Reuters

Recently, the IRS, Department of Labor, and Department of Health and Human Services issued final regulations regarding excepted benefits. Specifically, the new regs change the conditions for treating self-insured dental, vision and long-term care (LTC) coverages as excepted benefits. The regs also set the criteria under which employee assistance programs (EAPs) will constitute excepted benefits. Background Excepted benefits are exempt from certain group health plan mandates under a variety of legal conventions, including: The portability rules of the Health Insurance Portability and Accountability Act (HIPAA; for example, special enrollments), The Affordable Care Act (ACA; for instance, the age-26 and preventive-services mandates, enhanced claims and appeals rules, and annual dollar-limit prohibition), and Other laws (for example, federal mental health parity requirements)...

Published in Healthcare
Wednesday, 26 November 2014

ACA 2015: “Play or pay” on the way … and more

Written by Thomson Reuters

This year has been a trial run for the shared responsibility — or “play or pay” — provision of the Affordable Care Act (ACA). Large employers (as defined under the act) were supposed to have been at risk for financial penalties under the provision this year. But, with the penalties temporarily deferred, that risk was effectively eliminated. Barring any forthcoming legislative, regulatory or judicial action to the contrary, the play-or-pay provision essentially takes effect Jan...

Published in Healthcare
Tuesday, 04 November 2014

Accountable care organizations: Good in theory, slow to catch on

Written by Miranda Junga

The phrase “accountable care organization” (ACO) was coined in 2006. But it didn’t really start gaining currency until three years later when the concept was specifically addressed in the Affordable Care Act (ACA). ACOs are integrated health care provider systems that link provider reimbursements to established quality and efficiency goals. The theory is that, if the provider offers high-quality and well-coordinated care, patient outcomes will be good, costs will be controlled and the ACO will prosper...

Published in Healthcare
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