Healthcare

Friday, 29 August 2014

Lifting the veil on the ACA’s employer reporting forms

Written by Thomson Reuters

The IRS has lifted the veil on the forms that employers with at least 50 full-time employees or the equivalent will need to supply for plan years that begin in 2015. The purpose of the forms, mandated by Section 6056 of the Internal Revenue Code, is to help the IRS enforce the Affordable Care Act’s (ACA’s) shared responsibility (“play-or-pay”) provision for large employers and the individual mandate. The agency also wishes to confirm the eligibility of individuals who seek tax credits to help them afford coverage bought on a public Health Insurance Marketplace. Forms for all Form 1094-C is what employers will need to file with the IRS...

Published in Healthcare

Question: Our self-insured health plan doesn’t contain any exclusions or limitations for pre-existing medical conditions. Are we affected by the Affordable Care Act’s (ACA’s) rules prohibiting pre-existing condition exclusions (PCEs)? Answer: Yes. But, as we’ll explain further, the ACA should simplify your plan’s tracking of creditable coverage — but not until the end of 2014...

Published in Healthcare
Friday, 01 August 2014

Can Our Group Health Care Plan Impose Benefit-Specific Waiting Periods?

Written by Thomson Reuters

Question: To comply with the ACA, we changed the maximum waiting period under our calendar-year self-insured health plan to no more than 60 days. But the plan continues to impose some benefit-specific waiting periods of up to six months. Is our plan design compliant with legal requirements? Answer: Your plan's general 60-day waiting period would comply with the ACA's prohibition on "excessive" eligibility waiting periods...

Published in Healthcare
Friday, 01 August 2014

Reviewing the ACA's 0.9 Percent Additional Medicare Tax

Written by Thomson Reuters

As the year progresses, employers will need to begin withholding an extra 0.9 percent from the wages of more and more high-earners for the additional Medicare tax. This Affordable Care Act (ACA) provision went into effect last year. However, nothing is simple when it comes to new taxes...

Published in Healthcare
Tuesday, 22 July 2014

Health Care Plan Premiums for 2015: A Mixed Forecast

Written by Thomson Reuters

As the Affordable Care Act (ACA) was being debated in Congress in early 2010, the then Speaker of the House, Rep. Nancy Pelosi, famously commented, "We have to pass the [ACA] so that you can find out what is in it." A present day corollary is, "We won't know the impact of the ACA until it's been in effect for several years." Just when you think you've grasped the fundamentals of how the ACA affects your business and what you need to do to satisfy its requirements, a new regulation or legal challenge may alter the rules of the game, or at least compromise your previously established understanding...

Published in Healthcare
Tuesday, 22 July 2014

Newly Revised COBRA Model Notices Now Available

Written by Thomson Reuters

Employers must use notices to inform new hires of their rights to continuation health care coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Employees must also be informed via a notice of their right to buy COBRA coverage when departing from a job. Just this past May, the Department of Labor (DOL) issued revised model COBRA notices that include information about buying individual coverage through a health care exchange (also called a "Health Insurance Marketplace") as an alternative to COBRA coverage. More Info The model general notice now includes basic information about Marketplace coverage and provides a website address for more information...

Published in Healthcare

Question: We're considering the idea of forgoing a formal health insurance plan at our company. Instead, we'd like to direct our employees to a health care exchange (or "Health Insurance Marketplace") and then reimburse them for premiums paid there. Can we do this and still be in compliance with the ACA? Answer: No, the approach you describe is not permissible under the ACA...

Published in Healthcare
Wednesday, 09 July 2014

Patient-Centered Outcomes Research Institute Fee Due July 31

Written by Don McAnelly, CPA

The Patient-Centered Outcomes Research Institute Fee (PCORI) is due July 31, 2014. You still have time to act. The Patient-Centered Outcomes Research Institute Fee (PCORI fee) is intended to fund a Research Institute that will assist, through research, "the making of informed health decisions by advancing the quality and relevance of evidence based medicine." The fee will first be assessed to all fully-insured and self-fund plans, including health reimbursement arrangements, with plan years ending after September 30, 2012...

Published in Healthcare
Monday, 30 June 2014

Battle Lines: The Future of the Affordable Care Act

Written by Thomson Reuters

In the battle over the future of the Affordable Care Act (ACA), two camps are dug in and preparing for the next fight. The Obama administration and its congressional supporters hope enough Americans will have benefited from the law so that no substantial changes will be politically feasible after the next Congress is sworn in on January 3. The ACA's opponents, however, are hoping that in the November elections Republicans will maintain a strong majority in the House and gain control of the Senate, enabling a major overhaul of the law, if not its repeal. Which camp will prevail?..

Published in Healthcare
Monday, 30 June 2014

How Does the Clinical Trials Provision Affect Our Plan Exclusions?

Written by Thomson Reuters

Question: Our company's self-insured health plan contains an exclusion for experimental or investigational items and services. We have heard that the ACA includes a clinical trials mandate. Does this mean we'll need to amend our plan to start covering clinical trials? Answer: The ACA, in fact, doesn't require coverage of clinical trials...

Published in Healthcare
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