Healthcare

Monday, 02 October 2017

What’s the difference between a grandfathered and grandmothered plan?

Written by Thomson Reuters

Question: Our company sponsors a group health care plan, which is grandfathered for purposes of the Affordable Care Act (ACA). Recently, we encountered the term “grandmothered plan.” How do these differ from grandfathered plans? Answer: Grandfathered plans are group health plans (or health insurance coverage) that existed on March 23, 2010, and haven’t undergone certain prohibited design changes since...

Published in Healthcare
Monday, 02 October 2017

IRS releases draft instructions for 2017 Forms 1094 and 1095

Written by Thomson Reuters

In September, the IRS released draft instructions for health-care-coverage information-reporting Forms 1094/1095-B (B Forms) and Forms 1094/1095-C (C Forms) for the 2017 tax year. (The draft forms were released earlier in the summer.) Although the changes are minimal, employers should prepare themselves for the filing process. Background The B Forms are filed by minimum essential coverage (MEC) providers — mostly insurers and government-sponsored programs, but also some self-insuring employers and others...

Published in Healthcare
Monday, 02 October 2017

The evolution of price transparency (and its apparent limitations)

Written by Thomson Reuters

Who can resist a bargain? Employees, when buying health care services, it appears. A steady trickle of academic studies is making it clear that few employees are using available price comparison data to choose lower cost providers and packaged medical services. Search for clarity Price transparency tools were once seen as a potential panacea for rising health costs — particularly in light of the rise of high-deductible plans that give employees more skin in the game...

Published in Healthcare

Question: Our company maintains a medical plan for retirees and individuals on long-term disability. Can we continue to treat this plan as exempt from portability under the Health Insurance Portability and Accountability Act (HIPAA) and from the Affordable Care Act (ACA)? Answer: A retiree-only plan that also covers individuals on long-term disability can meet the requirements for exemption from compliance with HIPAA portability and the ACA — for the time being. Before the ACA, HIPAA rules included an exemption from most portability requirements (for example, special enrollment rights) if the plan had fewer than two participants who were current employees on the first day of the plan year...

Published in Healthcare
Wednesday, 30 August 2017

IRS finalizes regulations for premium tax credit relief

Written by Thomson Reuters

The IRS issued regulations in late July addressing the availability of premium tax credits under the Affordable Care Act (ACA) to two specific groups of individuals. The regs finalize previously issued temporary and proposed ones, largely without change. Here are some highlights for employers to keep in mind. Married victims of domestic abuse or abandonment The regulations adopt relief for certain married victims of domestic abuse or spousal abandonment...

Published in Healthcare
Wednesday, 30 August 2017

Employers to HHS: Give us a clearer, less onerous ACA

Written by Thomson Reuters

As of this writing, legislative efforts in Washington to repeal and replace the Affordable Care Act (ACA) appear to be on hold for the foreseeable future. Attention has now shifted to modifying the law’s more problematic provisions at the regulatory level. In June, the U.S...

Published in Healthcare
Wednesday, 26 July 2017

Small businesses: Major changes proposed for 2018 FF-SHOP enrollment

Written by Thomson Reuters

Note to readers: Efforts in Washington to repeal and replace the Affordable Care Act appear to have collapsed for the time being, but it’s possible efforts could be revived. Please bear this in mind as you read the article below, and consult your benefits advisor for the latest developments. The Small Business Health Options Program (SHOP) was created under the Affordable Care Act to establish a centralized marketplace where small employers and their employees could choose coverage, complete enrollment and pay premiums. A subset called FF-SHOP (“federally facilitated SHOP”) was also established to perform such functions in states that don’t have a state-based SHOP...

Published in Healthcare
Wednesday, 26 July 2017

Do we have to issue SPDs to health and welfare plan participants annually?

Written by Thomson Reuters

Question: In the past, we’ve provided participants with summary plan descriptions (SPDs) for our health and welfare plans every year. The plans are subject to the Employee Retirement Income Security Act (ERISA), but are we required to provide SPDs that often? Answer: Health and welfare plan SPDs don’t have to be routinely provided every year. Generally, health and welfare plan SPDs must be furnished to participants when they first become covered by a plan and then at specific intervals thereafter...

Published in Healthcare
Wednesday, 26 July 2017

HDHPs and the achievability of affordability

Written by Thomson Reuters

Note to readers: Efforts in Washington to repeal and replace the Affordable Care Act appear to have collapsed for the time being, but it’s possible efforts could be revived. Please bear this in mind as you read the article below, and consult your benefits advisor for the latest developments. Addressing the challenge of affordability, both from the employee and employer perspectives, is a key goal of health care reform past and present. But is affordability, by any realistic definition, actually achievable?..

Published in Healthcare
Thursday, 27 April 2017

What coverage must we offer to avoid “play or pay” liability?

Written by Thomson Reuters

Question: Our company recently grew to become an applicable large employer (ALE) under the Affordable Care Act (ACA). As the ACA remains in effect for the time being, could we get a refresher on what health care coverage must be offered to our employees? Answer: Of course. There are two types of penalties under the employer shared responsibility provisions of Internal Revenue Code Section 4980H — also known as the ACA’s “play or pay” provision...

Published in Healthcare
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