Healthcare

Monday, 30 June 2014

CMS Offers Small Businesses Guidance on Direct SHOP Enrollment

Written by Thomson Reuters

In late March, the Centers for Medicare and Medicaid Services (CMS) issued a bulletin clarifying the availability of small business tax credits to employers affected by technical difficulties with the newly launched state-based exchanges - now called "Health Insurance Marketplaces." Some background: Small businesses, as defined under the ACA, generally must receive an eligibility determination from a plan that qualifies under the Small Business Health Options Program (SHOP) before they can buy the qualifying health care plan through a Health Insurance Marketplace and potentially claim a small business health care tax credit. The new guidance allows state-based Health Insurance Marketplaces, with CMS approval, to use the same direct enrollment approach that the federally based Health Insurance Marketplace has already implemented for 2014 as a transitional measure. Direct enrollment, for this purpose, means that eligible small employers may work directly with an agent, broker or insurer to buy coverage and enroll their employees in a qualifying health care plan without first obtaining a SHOP-eligibility determination...

Published in Healthcare
Wednesday, 11 June 2014

IRS Clarifies Its Position on Contributing to Employee Health Coverage

Written by Thomson Reuters

Last year, the IRS spelled out how it would treat employer contributions to employees to help them buy coverage on their own. More recently, it reiterated its position in Q&A format. The question the IRS posed to itself: What are the consequences to the employer if the employer does not establish a health insurance plan for its own employees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health plan in the marketplace or outside the marketplace)? Employer Payment Plans In answering its own question, the IRS characterized such arrangements as "employer payment plans...

Published in Healthcare
Tuesday, 10 June 2014

Final Regulations Issued on 90-day Waiting Requirement

Written by Don McAnelly

The U.S. Departments of Labor, Treasury, and Health and Human Services have announced the publication of final regulations implementing a 90-day limit on waiting periods for health coverage. The final regulations require that no group health plan or group health insurance issuer impose a waiting period that exceeds 90 days after an employee is otherwise eligible for coverage...

Published in Healthcare
Tuesday, 03 June 2014

New Law Repeals Mandated Annual Deductible Cap For Small Group Policies

Written by Thomson Reuters

This past April, Congress passed and the president signed into law the Protecting Access to Medicare Act of 2014. It primarily postpones, yet again, changes to the formula used to determine the amounts Medicare pays physicians for services. But, in a secondary function of particular interest to many small businesses, the legislation also eliminates limitations on annual deductibles previously mandated under the ACA. As though it Never Happened According to the now-eliminated ACA provision, starting in 2014, annual deductibles for health care plans were to max out at $2,000 for a plan covering a single individual and $4,000 for any other plan (indexed for increases in health insurance costs)...

Published in Healthcare
Tuesday, 03 June 2014

Gearing Up for the ACA's "Cadillac Tax"

Written by Thomson Reuters

Employers have plenty of reasons to hit the brakes on the cost of their health care plans. One good example: They want to keep costs down so they can stay in business. But there's another intimidating motivator looming on the horizon. In 2018, some employers will face a 40 percent excise tax on plan values that exceed a prescribed cap under the Affordable Care Act (ACA)...

Published in Healthcare
Tuesday, 03 June 2014

Must Our Plan Comply With the ACA's Excessive Waiting Period Rules?

Written by Thomson Reuters

Question: We sponsor a grandfathered, non-calendar-year self-insured health plan that imposes a three-month eligibility waiting period. (Our next plan year begins on August 1, 2014.) As an employer with a grandfathered plan, are we required to comply with the ACA's prohibition on excessive waiting periods? And, if so, would we be in compliance with the existing three-month waiting period?..

Published in Healthcare
Monday, 19 May 2014

Proposed Regulations Address ACA's "Excepted" Benefits

Written by Thomson Reuters

The ACA and other federal health coverage laws "except" some employee benefits from certain requirements that otherwise apply to health plans. Examples of excepted benefits include limited-scope dental and vision coverage and disability insurance. These benefits are excepted because they aren't considered health coverage; they're offered separately or aren't an integral part of benefits under a group plan. New proposed regulations — issued by the Departments of Labor, Treasury and Health and Human Services in January — amend the regs on excepted benefits regarding vision and dental benefits, employee assistance programs (EAPs), and "wraparound" coverage...

Published in Healthcare
Monday, 19 May 2014

Play-or-Pay update: Final Regs Offer Clarity, Breathing Room

Written by Thomson Reuters

Fully understanding and adapting to the ACA hasn't been easy on any organization — be it for-profit, nonprofit or government entity. In an effort to provide clarification and give midsize to large employers breathing room regarding the act's shared-responsibility ("play or pay") provision, the IRS released final regulations in February. These final regs defer an important deadline for some employers and offer other transitional relief throughout 2015. Reviewing the Basics The play-or-pay provision imposes a penalty on large employers that don't offer "minimum essential" health care coverage — or that offer coverage that isn't "affordable" or doesn't provide at least "minimum value" — to their full-time employees (and their dependents) if just one full-time employee enrolls in a qualified health plan through a government-run Health Insurance Marketplace (originally referred to as a "health insurance exchange") and receives a premium tax credit...

Published in Healthcare
Monday, 19 May 2014

The State of SHOP Plans (and Where they're Headed)

Written by Thomson Reuters

The Affordable Care Act (ACA) Small Business Health Options Program (SHOP) got off to a slow start. Many factors behind the sluggish launch, however, theoretically won't weigh it down in 2015. So now might be a good time for small employers to begin planning for next year — even though you can enroll in SHOP plans anytime before then and still possibly qualify for a tax credit. SHOP Basics SHOP plans were intended to make it easier for small businesses to find affordable health care coverage to offer employees...

Published in Healthcare
Tuesday, 13 May 2014

Addressing the Section 105 Medical Reimbursement Plan

Written by Miranda Junga

The Affordable Care Act (ACA) has brought about many changes for small businesses. If you're still processing the many options available to your organization, you're not alone. One that may be worth your consideration is the Section 105 Plan. The Section 105 Plan is a health reimbursement arrangement funded solely by an employer that reimburses an employee for medical care expenses incurred by the employee, his or her spouse, dependents, and children who, as of the end of the taxable year, have not reached 27 years of age...

Published in Healthcare
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