Healthcare

Wednesday, 31 January 2018

HHS happenings: Agency addresses 2019 parameters and more

Written by Thomson Reuters

Late last year, the Department of Health and Human Services (HHS) released proposed regulations that include the benefit and payment parameters for 2019. The regs also include a host of other potential rules related to the insurance market and Health Insurance Marketplaces (commonly known as “exchanges”). The agency’s proposals are largely aimed at insurers and state regulators, but there are some provisions that may be of interest to employers and their advisors. Here are some highlights: Increased annual cost-sharing limits...

Published in Healthcare
Wednesday, 31 January 2018

Giving lower-paid employees a break on health plan cost-sharing

Written by Thomson Reuters

A relatively small but growing number of employers are cutting lower-paid employees some slack when it comes to the high costs of health care. Essentially, they’re adjusting the cost of these workers’ health benefits according to their incomes. Such a strategy probably isn’t an option for many small businesses. But midsize and larger employers could consider it as a way to neutralize the impact of employing workers in different regions, where wages and health costs vary...

Published in Healthcare
Thursday, 04 January 2018

Can HSA contributions continue after an employee becomes ineligible?

Written by Thomson Reuters

Question: Our cafeteria plan allows employees who participate in our high-deductible health plan (HDHP) to make pretax Health Savings Account (HSA) contributions. When an employee drops our HDHP coverage, HSA contributions are immediately discontinued. Is this necessary? Could we amend our plan to let employees continue contributing through the end of the year, whether or not they have obtained HDHP coverage elsewhere, until they reach the maximum contribution for the portion of the year in which we’re confident they were HSA-eligible?..

Published in Healthcare
Thursday, 04 January 2018

IRS releases forms related to employer mandate penalties

Written by Thomson Reuters

As it prepares to assess penalties for noncompliance with the employer mandate for the first time, the IRS has released Forms 14764 and 14765. The potential penalties pertain only to applicable large employers (ALEs) that fail to offer adequate health coverage to enough of its full-time employees and full-time equivalents, as defined under the Affordable Care Act. The IRS recently updated Q&A guidance on the employer mandate to explain the procedure it will use to assess liability under Internal Revenue Code Section 4980H for the 2015 calendar year. This includes issuance of a Letter 226J, which is the initial IRS notification to an ALE of a proposed penalty amount...

Published in Healthcare
Thursday, 04 January 2018

Insurance trends: Stop-loss coverage growing more popular

Written by Thomson Reuters

Health benefits costs are continuing their steady march upward for most employers. Premium expenses have gone up in the 4% to 6% average range for 2018, according to some surveys (including consultancy Mercer’s National Survey of Employer-Sponsored Health Plans 2017). But such numbers belie self-insured employers’ risk of getting slammed by catastrophic claims that could blow their cost trend lines out of the water. To blunt the impact of such a disaster, many employers cap their liability with stop-loss insurance...

Published in Healthcare
Monday, 04 December 2017

IRS releases 2018 COLAs for various health care benefits

Written by Thomson Reuters

In October, the IRS released the 2018 cost-of-living adjustments (COLAs) for a wide variety of tax-related limits applicable to various health care benefits. Here are some of the highlights: Health Flexible Spending Accounts (FSAs). For 2018, the dollar limit on employee salary reduction contributions to health FSAs will be $2,650, up from $2,600. Qualified small employer health reimbursement arrangements (QSEHRAs)...

Published in Healthcare
Monday, 04 December 2017

Make next year even better by establishing a culture of health

Written by Thomson Reuters

About a decade ago, the New England Journal of Medicine published a landmark study that identified a social dimension to the spread of obesity. The study found, among other things, that a person’s chances of becoming obese increase by 57% if he or she has a friend who also becomes obese. Many, if not most, employees have co-workers they consider friends. So, in turn, a workplace’s “culture of health” — defined as a culture that supports or neglects healthy living — can have a major impact on workers’ well-being...

Published in Healthcare
Monday, 04 December 2017

Does a midyear deductible change require an SBC update?

Written by Thomson Reuters

Question: Our company sponsors a self-insured major medical plan subject to the Employee Retirement Income Security Act of 1974 (ERISA). We’re considering amending our plan midyear to increase the amount of the deductible, with no other changes in the plan terms. Are we required to update our summary of benefits and coverage (SBC) for this change or otherwise provide notice? Answer: Yes, increasing the deductible under your plan would constitute a “material modification” that would trigger a notice requirement under ERISA...

Published in Healthcare
Monday, 20 November 2017

Return to sender: ER regs sent back for further explanation

Written by Thomson Reuters

A federal court recently ruled that the IRS, Department of Labor and Department of Health and Human Services had acted arbitrarily and capriciously in adopting final regulations under the Affordable Care Act (ACA) patient protection provisions for emergency room services. The decision came about in response to a challenge by various health care providers. Transparency concerns Under the ACA, group health plans cannot impose higher co-payments or co-insurance amounts for emergency medical treatment simply because the treatment was provided by an out-of-network provider. Under interim final rules published in June 2010, a plan satisfies these limitations if it pays benefits for out-of-network emergency services in an amount equal to the greatest of three possible amounts: The median amount paid to in-network providers for the emergency service, excluding in-network co-payments or co-insurance, The amount for the emergency service calculated using the same method the plan generally uses to determine payments for out-of-network services ― such as usual, customary and reasonable (UCR) charges ― but substituting the in-network co-payment or co-insurance amount for the out-of-network amount, or The amount that would be paid under Medicare...

Published in Healthcare
Friday, 20 October 2017

Executive order could change health care benefits landscape

Written by Thomson Reuters

On October 12, President Trump issued an executive order entitled “Promoting Healthcare Choice and Competition Across the United States,” aimed at letting small businesses join forces across state lines to buy lower cost, less regulated health plans with fewer benefits for employees. The order also encourages federal agencies to lengthen the coverage periods of short-term limited-duration plans and expand Health Reimbursement Arrangements (HRAs). The executive order doesn’t alter any of the Affordable Care Act’s (ACA’s) basic employer mandate or reporting provisions. The same day, the Trump administration announced that it would no longer pay ACA subsidies, or “cost sharing reductions,” to private health insurers for coverage of low-income people...

Published in Healthcare
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