Don't forget about employee ACA communication due Oct. 1
Originally posted by Keith R. McMurdy August 16, 2013 on https://eba.benefitnews.com
With the recent employer mandate delay, some businesses might be overlooking the requirement to provide a notice to employees about health insurance coverage that may be available through a public exchange.
Employers must provide a notice to each employee, regardless of plan enrollment status or part-time or full-time status, by Oct. 1. The notice must be provided automatically, free of charge, and written in language that the average employee can understand. It may be provided by first class mail or electronically, if the requirements of the U.S. Department of Labor’s electronic disclosures safe harbor are met. It must also be provided to new hires — for 2014, the DOL will consider a notice delivered timely to a new employee if it’s provided within 14 days of the start date.
The notice must inform each employee of three things:
- The existence of state or federal health insurance exchanges.
- If the employer plan’s share of the total allowed costs of benefits provided under the plan is less than 60%, then the employee may be eligible for a federal premium tax credit if the employee purchases a qualified health plan through an exchange.
- If the employee purchases a qualified health plan through an exchange, then the employee may lose the employer contribution to any health benefits plan offered by the employer; also, all or a portion of such contribution may be excludable from income for federal income tax purposes.
The good news is that employers don’t have to create the notices from scratch. The DOL published model notices, one for Employers Who Offer Health Plans, and one for Employers that Do Not Offer Health Plans. If employers have questions about how to complete the forms, this is an opportunity for an employee benefit adviser to step in and provide guidance. Above all, advisers should remind employers that they need to issue them. Just because employers have a year to wait on the coverage mandate does not mean they can ignore other compliance rules like this one.
Should exchanges be part of your company's plan?
Originally posted August 06, 2013 by Justyn Harkin on https://ebn.benefitnews.com
Although considering the new health care exchanges may have seemed radical a few weeks ago, now that everybody gets to drop ten and punton the employer mandate penalty in 2014, the idea may not be so strange.
Sure, migrating employees to the exchanges isn’t right for every organization. If the move would upset your workforce, then keeping your current group plan is probably best. But if employees would view exchange offerings as equal or better than what they current have, then there could be plenty of upsides.
If you think the exchanges would be better than what you have now for both your company and your employees, or even if you just want to get a leg up on communications (and believe me, that’s never a bad idea), then you and your employees have three options — public exchanges, private exchanges (fully insured), private exchanges (self-insured).
Which one might be best for your organization? Let's see.
Public exchanges
One of the most attractive ideas about moving to a public exchange has to be handing over the considerable financial and administrative burdens for running your company’s health benefits.
For some organizations, the move might be cheaper than what they are doing now. Even when you factor in the likely, eventual activation of the $2,000-per-employee fine for not providing insurance, you could still be paying less than what you would if you were covering premiums.
Of course, sending employees to public exchanges isn’t necessarily a slam-dunk move. Your workforce could straight-up riot if you tell them you’re cutting health benefits, and even if you raise salaries (oh, hello there, higher payroll taxes) to help them cover the costs of buying their own insurance, your recruiting efforts could take a hit if your competitors keep their health benefits.
Private exchanges with fully insured plans
Perhaps the biggest advantage of using a private exchange is the ability to shift some of the rising costs of health care to employees and give them the ability to control their spending.
In a private exchange, employees get an allowance from their employer that can be used to buy insurance. The idea is that giving employees control of the purchasing decision takes some of the heat off of your company. After all, if the cost of health care rises, that’s not your fault?
So what’s the downside to this type of exchange? Well, in the worse-case scenario it’s a less healthy, less productive workforce. Because employees will be making purchasing decisions, they may choose lower premiums over better coverage, and that can contribute to poorer health and higher rates of absenteeism.
Private exchanges with self-insured plans
The last of your exchange options are private exchanges with self-insured plans. Compared with the types of plans offered on public exchanges and private exchanges with fully insured plans, the plans available on private exchanges with self-insured plans can seem very attractive employees — generally lower premiums, more generous plan features, and more in-network doctors — but they will be more expensive.
The self-insured private exchange option might be slightly more expensive than what you could do with a fully insured private exchange, that’s true, but the available plans would be more oriented toward long-term health.
Still, using self-insured plans means you’ll have to assume all the risk and pay for all your employees’ claims. Also your employees will become customers of the private exchange insurance companies, and that means you won’t have the same influence (over the companies or choices) that you would otherwise have.
How will you spend the bonus year?
Assistant Secretary for Tax Policy Mark J. Mazur’s July 3 announcement might have seemed like the best health care reform–related thing to happen to employers all year.
If you take the “transition year” at face value, meaning the mandatory employer and insurer reporting requirements are being postponed, then you have the perfect chance to carefully consider your company’s next moves.
Maybe you’ll decide to take the plunge. Perhaps you’ll rule out the exchanges altogether. You might even decide to let other companies test the waters first so you can be prepared later on.
No matter what path you chose, though, the most important thing is taking the time to make the best decision for your company and your employees. And then communicate that decision in a clear and engaging way. Good luck!
House-passed bill would bar IRS enforcement of health care reform law
Originally posted August 2, 2013 by Jerry Geisel by https://www.businessinsurance.com
The House of Representatives approved legislation Friday that would bar the U.S. Treasury Department and Internal Revenue Service from enforcing the health care reform law.
The Republican-backed measure cleared the House on a 232-185 vote.
Under the bill, H.R. 2009, regulators would be unable to enforce key health care reform law provisions such as the requirement — delayed last month by the Treasury Department to 2015 — that employers with at least 50 full-time employees offer coverage or pay a fee and a 2014 requirement that individuals enroll in a health plan or pay a fine.
The bill — as has been the case with other measures approved by the House to repeal all or part of the Patient Protection and Affordable Care Act — is unlikely to be taken up by the Senate, where Democrats hold the majority.
Even if the Senate were to pass the House measure, President Barack Obama would veto it.
The legislation “would raise health insurance premiums and increase the number of uninsured Americans and represents another attempt to repeal the Affordable Care Act, with no plan to replace it or policy to improve it,” the administration said in a statement by the Office of Management and Budget earlier this week.
Instead of attempting to repeal the reform law, lawmakers should work with the administration on an agenda to provide greater economic security to the middle class, the administration said in the statement.
Rep. Tom Price, R-Ga., who introduced the latest House measure to repeal the law, said earlier that “we ought to take this common sense step to take the IRS out of health care.”
Feds add exchange employer site
Originally posted August 2, 2013 by Allison Bell on https://www.benefitspro.com
Three federal agencies have joined to set up a Patient Protection and Affordable Care Act website for small businesses.
Business.USA.gov/healthcare offers a "wizard," or interactive tool, that offers to help business owners understand what they need to know about the new PPACA insurance options in a few quick steps.
The Small Business Administration worked with the U.S. Department of Health and Human Services and the U.S. Treasury Department to set up the site.
The wizard starts by asking visitors about their companies' location and size.
On the size menu, for example, the wizard asks whether the user is self-employed with no employees, has fewer than 25 employees, has up to 50 employees, or has 50 or more employees.
The site includes an explanation of how an employer can determine whether it has 50 or more full-time or full-time equivalent employees.
Users who, say, might want to set up group health plans will see information about the new PPACA Small Business Health Options Program small-group exchange program.
In most states, in the pages of information for employers interested in setting up health plans, the SBA gives an answer to the question, "Can I use an agent or broker to buy health insurance in the marketplace?"
"You will be able to use a licensed agent or broker to provide help or handle your SHOP business," the SBA says. "You won't pay more if you use a SHOP agent or broker."
For users in Vermont, a state that is trying to eliminate small-group market broker commissions, the SBA makes no mention of agents and brokers.
NAHU: Employer mandate delay 'necessary' despite $12 billion cost
Originally posted July 30, 2013 by Alex Wayne (Bloomberg) and EBA staff on https://eba.benefitnews.com
A National Association of Health Underwriters spokeswoman says that while there are "short-term financial repercussions" to the employer mandate delay, "we believe this delay was necessary to continue the economic upturn we have seen in the past few months and ensure that American businesses will be able to provide their employees with the health insurance they want and need in the long term.”
President Barack Obama’s decision to give employers a year before they’re required to provide health insurance for workers will cost taxpayers $12 billion, the Congressional Budget Office says in a letter to members of Congress.
The health law will now cost $1.375 trillion through 2023, an increase of $12 billion since May, the CBO says. The government will lose $10 billion in penalties that companies would have paid next year for not providing employee health plans, and taxpayers will spend $3 billion more on subsidies for workers who instead will buy coverage on the exchanges.
The White House announced the delay on July 2, in response to a lobbying effort from business groups. The Affordable Care Act requires companies with 50 or more workers to offer health insurance to their workers or pay fines of as much as $3,000 per employee if they don’t. Now, companies don’t have to provide coverage until 2015.
“Some large employers that would have offered health insurance coverage to their employees in 2014 will no longer do so as a result of the one-year delay of penalties for those that do not offer affordable coverage,” Douglas Elmendorf, the director of the CBO, wrote in the letter.
The costs of the delay were offset by about $1 billion because of “small changes,” CBO said, including an increase in income tax collections from people who don’t get coverage at work. The value of employer-provided health insurance isn’t taxed, while workers who get higher pay to buy insurance on their own would have to pay income tax on that compensation. CBO also reports that “one million fewer people are expected to be enrolled in employment-based coverage in 2014” than the group predicted in May, also due to the employer mandate delay.
Even with the mandate’s delay, the health law is projected to reduce the deficit, the CBO says, because of lower Medicare spending and other provisions that offset the cost of new coverage. The CBO said May 15 that repealing the law would cost the federal government $109 billion, a figure it didn’t update today.
Alternative Treatments Could See Wide Acceptance Thanks to Health Care Reform
by: KAISER HEALTH NEWS AND ANKITA RAO
The Affordable Care Act says that insurance companies "shall not discriminate" against any state-licensed health provider, which could lead to better coverage of chiropractic, homeopathic and naturopathic care. Photo by Joe Raedle/Getty Images.
Jane Guiltinan said the husbands are usually the stubborn ones.
When her regular patients, often married women, bring their spouses to the Bastyr Center for Natural Health to try her approach to care, the men are often skeptical of the treatment plan -- a mix of herbal remedies, lifestyle changes and sometimes, conventional medicine.
After 31 years of practice, Guiltinan, a naturopathic physician, said it is not uncommon for health providers without the usual nurse or doctor background to confront patients' doubts. "I think it's a matter of education and cultural change," she said.
As for the husbands -- they often come around, Guiltinan said, but only after they see that her treatments solve their problems.
Complementary and alternative medicine -- a term that encompasses meditation, acupuncture, chiropractic care and homeopathic treatment, among other things -- has become increasingly popular. About four in 10 adults (and one in nine children) in the U.S. are using some form of alternative medicine, according to the National Institutes of Health.
And with the implementation of the Affordable Care Act, the field could make even more headway in the mainstream health care system. That is, unless the fine print -- in state legislation and insurance plans -- falls short because of unclear language and insufficient oversight.
One clause of the health law in particular -- Section 2706 -- is widely discussed in the alternative medicine community because it requires that insurance companies "shall not discriminate" against any health provider with a state-recognized license. That means a licensed chiropractor treating a patient for back pain, for instance, must be reimbursed the same as medical doctors. In addition, nods to alternative medicine are threaded through other parts of the law in sections on wellness, prevention and research.
"It's time that our health care system takes an integrative approach ... whether conventional or alternative," said Sen. Tom Harkin, D-Iowa, who authored the anti-discrimination provision, in an e-mail. "Patients want good outcomes with good value, and complementary and alternative therapies can provide both."
The federal government has, in recent years, tapped providers like Guiltinan, who is also the dean at the Bastyr University College of Naturopathic Medicine, to help advise the federal government and implement legislation that could affect the way they are paid and their disciplines are incorporated into the health care continuum. In 2012, Guiltinan, based in Kenmore, Wash., was appointed to the advisory council of the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health.
Proving that alternative medicine has real, measurable benefits has been key to increasing its role in the system, said John Weeks, editor of the Integrator Blog, an online publication for the alternative medicine community. The Patient-Centered Outcomes Research Institute, created by the health law, is funding studies on alternative medicine treatments to determine their effectiveness.
Weeks said both lawmakers and the general public will soon have access to that research, including the amount of money saved by integrating other forms of medicine into the current health system.
But the challenges of introducing alternative care don't stop with science.
Because under the health care law each state defines its essential benefits plan -- what is covered by insurance -- somewhat differently, the language concerning alternative medicine has to be very specific in terms of who gets paid and for what kinds of treatment, said Deborah Senn, the former insurance commissioner in Washington and an advocate for alternative medicine coverage.
She pointed out that California excluded coverage for chiropractic care in its essential benefits plan, requiring patients to pay out of pocket for their treatment. Senn thinks the move was most likely an oversight and an unfavorable one for the profession. Four other states -- Colorado, Hawaii, Oregon and Utah -- ruled the same way in the past year.
"That's just an outright violation of the law," she said, referring to the ACA clause.
Colorado and Oregon are in the process of changing that ruling to allow chiropractic care to be covered, according to researchers at Academic Consortium for Complementary and Alternative Health Care.
Some states, like Washington, are ahead of the rest of the country in embracing alternative practitioners. The Bastyr University system, where Guiltinan works, treats 35,000 patients a year with naturopathic medicine. Sixty percent of the patients billed insurance companies for coverage.
Guiltinan said a change in the system is not only a boon for alternative medicine doctors, but helps families of all income levels access care normally limited to out-of-pocket payment. That's why some alternative medicine aficianados like Rohit Kumar are hoping the law will increase the ability of his family -- and the larger community - to obtain this kind of care.
Kumar, a 26-year-old business owner in Los Angeles, said his parents and brothers have always used herbs and certain foods when they get sick, and regularly see a local naturopath and herbalist. He's only used antibiotics once, he says, when he caught dengue fever on a trip to India.
While the Kumar family pays for any treatments they need with cash -- the only payment both alternative providers accept -- they also pay for a high-deductible health plan every month to cover emergencies, like when his brother recently broke his arm falling off a bike.
Paying for a conventional health care plan and maintaining their philosophy of wellness is not cheap.
"We pay a ridiculous amount of money every month," Kumar said of the high-deductible insurance. "And none of it goes toward any type of medicine we believe in."
Even so, he said the family will continue to practice a lifestyle that values wellness achieved without a prescription -- a philosophy that Guiltinan also adopted in her practice.
As a young medical technician in a San Francisco hospital, she decided that the traditional medical system was geared more toward managing diseases and symptoms rather than prevention. Naturopathic medicine, on the other hand, seemed to fit her idea of how a doctor could address the root cause of illness.
"The body has an innate ability for healing, but we get in its way," Guiltinan said. "Health is more than the absence of disease."
How to Best Inform Employees About PPACA
Originally posted July 29, 2013 by Thom Mangan on https://eba.benefitnews.com
Benefit education has long been considered a key component of a successful employee benefit program. However, engaging employees and helping them recognize the value of their program is not easy. It takes ongoing efforts of HR Managers with support from senior management.
The Affordable Care Act creates another new wrinkle for HR managers. I caught up with UBA Partner, Greg Smith of R.W. Garrett Agency, to find out how best to get your employee’s attention — and why it’s so important.
Thom: In addition to the mandated communication material and benefit changes, how does PPACA affect an employer’s communication efforts?
Greg: With the new health insurance marketplaces and Medicaid expansion in most states, the government has a daunting task of educating and informing millions of the nation’s uninsured of the new coverage and subsidies available to them.
To get the word out, the government will spend hundreds of millions of dollars in a broad and expansive advertising campaign starting this month (July).
Employers are also participating in the campaign, as they are required to send out a Model Notice regarding coverage and options in the New Health Insurance Marketplaces.
The Marketplaces and corresponding advertising campaign are focused on the uninsured, who may be eligible for “free” coverage (through Medicaid) or subsidized, reduced premium coverage (in the New Insurance Marketplaces). However, if the employer’s plan provides adequate and affordable coverage, the employees eligible for the plan will not qualify for any subsidized coverage in the New Insurance Marketplace (unless eligible for Medicaid).
Thom: So where does the trouble come in?
Greg: The wrinkle comes from two sources – confusion and human nature:
1. Confusion – Unless explained adequately, the employee may be confused as to why his employer is sending him notice of a New Insurance Marketplace with subsidized coverage, when, in fact, he is not eligible for a subsidy.
2. Human Nature – Employees may misinterpret or misunderstand the message of the government’s advertising and think that by dropping coverage, they may get a better deal in the Marketplace or, worse, believe that their benefits are not as valuable as they are.
Thom: So what is an employer to do to get around these problems, or “wrinkles”?
Greg: I believe employers can get out ahead of the “wrinkle” by pre-empting the government’s advertising with communications of their own. They can lay out the facts of the advertising campaign and reinforce the quality of their own plan.
Just because the White House has delayed the implementation of the employer mandate part of the Affordable Care Act doesn’t mean employers don’t have to communicate options to employees. On the contrary, they would be wise to use the extra year to make sure they and their employees are adequately prepared for the pending changes of 2015.
How the ACA affects annual enrollment
Originally published July 25, 2013 by Andrew Molloy on https://ebn.benefitnews.com
Despite the one-year delay of the pay-or-play mandate, there are still several provisions employees need to know about.
With annual benefit enrollments on the horizon, employers need to be prepared now for the changes that health care reform is bringing. Hopefully, employees already know that as of Jan. 1, 2014, they must have health insurance coverage. Beyond this mandate, however, what are some of the other issues of which employers should be aware?
The Affordable Care Act requires employers to tell their employees in writing by Oct. 1 about the new public health care exchanges and how these relate to their workplace benefits. This requirement applies to all employers subject to the Fair Labor Standards Act.
Under the law, employees need to know that they may be eligible for a tax credit and cost-sharing reduction if their employer's plan does not meet certain coverage and affordability requirements and the employee purchases a qualified health plan through a public exchange. Employers must also inform workers that if they choose to purchase their coverage through an exchange, they may not receive any employer contribution toward their premium, nor any related tax advantage.
Employees may still be confused about the exchanges by the time of enrollment. For the most part, those who work for large employers will see little impact since the subsidies offered for a qualified employer-sponsored medical plan will make the choice moot. However, employees of small- to medium-sized companies where health insurance is not available, or isn't affordable, will have to make a decision about whether to go to a public exchange for their coverage. For these employers, it means telling their workers what their options are and are not.
Despite the recently announced one-year delay in the employer shared responsibility requirement, employers still have obligations for 2014 and they'll have to review their medical plans carefully to ensure they meet the essential health benefits mandated by the law. In addition, the plan cannot have any annual coverage limits; cannot exclude people with pre-existing health conditions; must extend coverage to children up to age 26; and must comply with limits on deductibles and out-of-pocket expenses, among other requirements. It is also important to note that the requirement for essential health benefits applies only to individual and small group plans; the requirement does not exist for self-insured plans.
With the pay-or-play delay, employers will not be penalized if their plans do not cover at least 60%, on average, of an employee's health care costs in a given year, or if an employee's premium costs exceed 9.5% of his or her income. Those employees may still be eligible for tax credits on the public exchange, but for 2014 employers will not be subject to penalties if employees receive those tax credits.
Financial responsibility
It's clear that shifts in financial responsibility will continue to affect today's benefits picture. As employers feel the pressure of rising costs and enrollments in their health plans, they are likely to further fuel the already rapid growth of consumer-directed health plans. In fact, 52% of employers surveyed recently anticipated introducing high deductible/consumer-driven health plans in the next three to five years.
Employers should be aware that employees will see any loss of medical coverage or increase in cost sharing as a reduction in compensation. Consequently, employers will need to pay more attention to their company's total benefits package and consider ways to preserve or increase its value.
Above all, during this transitional period of health care reform, employers must clearly communicate benefits options and their value to employees. Employees need to understand that in most cases, their health benefits will remain the same and they won't have to go to the public exchanges for their coverage. They should also be educated about the need for disability coverage and its value.
Using multiple enrollment methods and a variety of learning tools will help ensure a successful benefits enrollment. In fact, research shows that participation is highest when employees have at least three weeks to absorb their benefits-education information, with at least three different ways to learn about their choices.
Delay of health reform mandate has employers making hard benefit choices
Originally posted July 14, 2013 by Jerry Geisel on https://www.businessinsurance.com
Some employers may offer health insurance despite mandate delay.
Affected employers face some tough decisions on what approach they will take in the wake of the Obama administration's unexpected decision to delay a key health care reform law provision.
Administration officials this month delayed by one year to 2015 the Patient Protection and Affordable Care Act requirement that employers with 50 or more employees offer qualified coverage to at least 95% of their full-time employees or pay a $2,000 penalty for each full-time employee.
U.S. Treasury Department officials said the delay was necessary to give the agency more time to simplify how employers are to file health care plan enrollment information with the government.
That delay is being welcomed by employers, especially those who have not decided whether they will offer coverage to those not currently eligible; or, if they have decided, the generosity of the coverage they will provide.
“This is a rare opportunity where an employer can make a smart and thoughtful decision,” said John McGowan, a partner with the law firm Baker & Hostetler L.L.P. in Cleveland.
Some employers, especially those that already have told affected employees that they will expand coverage, are less likely to reverse course and hold off that expansion for another year.
“If you already have figured out your strategy, you probably will implement it,” said J.D. Piro, a senior vice president with Aon Hewitt in Norwalk, Conn.
For example, Cumberland Gulf Group in June announced that, effective Oct. 1, employees working as few as 32 hours a week will be eligible for group coverage, down from the current 40-hour-a-week requirement.
Employees working 30 or 31 hours a week will be given the option of working 32 hours to become eligible for coverage in the company's self-insured plans. For employees who work less than 30 hours, the company will assist them in finding coverage through public insurance ex-changes.
Through that expansion of coverage, which will affect about 1,500 employees, Cumberland Gulf, a $15 billion Framingham, Mass.-based company that owns convenience stores and the Gulf Oil brand, will be shielded from the health care reform law's $2,000 per-employee penalty, which is triggered when coverage is not offered to full-time employees — those working at least 30 hours per week.
That expansion of coverage will remain on track, said John McMahon, Cumberland Gulf's senior vice president and chief of human resources.
“We are going to continue on the path we have laid out. Our strategy is to create a great place to work and to be an employer of choice,” Mr. McMahon said, adding that the company is getting very positive feedback from current and prospective employees.
Other employers who also have announced plans to expand coverage eligibility, though, may find themselves between a “rock and a hard place,” said Ed Fensholt, senior vice president and director of compliance services for Lockton Benefit Group in Kansas City, Mo.
Those employers “will have to weigh the cost savings by pulling the plug for a year with the confusion and damage to employee relations that would occur,” Mr. Fensholt said.
Employers that do not offer coverage to all eligible employees and have not made final decisions on whether they will expand coverage also face issues.
For example, if they wait until 2015 to offer coverage, they could be at a disadvantage if their competitors decide to extend coverage next year, said Steve Wojcik, vice president of public policy at the National Business Group on Health in Washington.
There are other issues for employers not currently offering coverage to consider. By not offering coverage, their lower- and middle-income employees will be eligible for premium subsidies to purchase policies from insurers offering coverage in public insurance exchanges.
Then, in 2015, when the coverage mandate kicks in, the employer could offer a plan that is just rich enough to pass the law's minimum value test, denying employees the government subsidies for exchange coverage they received in 2014.
“Then, you have an employee relations issue,” Mr. Fensholt said.
That issue will be less likely to develop, experts say, if the employees received employer coverage beginning in 2014 and never enrolled in exchanges.
“Some employees will be disappointed. It could be an awkward situation,” said Frank McArdle, an independent benefits consultant in Bethesda, Md.
Still, there are plenty of employers not providing coverage who will decide against offering coverage in 2014.
Employers “may not want to move forward until the dust settles. Some are wondering if the regulations and requirements will actually change during this interim period,” said Michael Thompson, a principal with PricewaterhouseCoopers L.L.P. in New York.
In addition, by waiting, employers will have a better sense of whether Congress will act in the coming months to change the employer mandate, experts say.
For example, prior to the Treasury Department delay, bills were introduced that would change the definition of a full-time employee to those working 40 hours a week — compared with the law's 30-hour threshold — while other measures would exempt more small employers from the requirement to either offer coverage or pay the $2,000 per-employee fine.
While it is difficult to imagine Congress reaching a bipartisan consensus, “anything is possible,” said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.
8 reasons for employers to keep their PPACA guard up
Originally published July 17, 2013 by Dan Cook on https://www.benefitspro.com
Now that the celebrations have died down over the one-year delay of penalties for employers who don’t meet the PPACA coverage requirements, it’s time to take a close look at what does remain in effect.
The very short answer to the question is that there’s still quite a bit on the books, and that, really, only the teeth have been (temporarily) removed.
Here’s what the national law firm Bryan Cave had to say about which PPACA provisions remain in effect for employers in the year ahead.
1. Summaries of Benefits and Coverage must be distributed during open enrollment for the 2014 coverage period and must indicate whether the plan provides minimum value, as defined under the PPACA.
2. Exchange Notices: Employers must distribute PPACA exchange notices to employees by Oct. 1, 2013, and thereafter to new employees upon hire.
3. Application for Advance Premium Credits: Employers are required to complete a 12-page form entitled, “Application for Health Coverage and Help Paying Costs” when requested by employees who are applying for PPACA advance premium tax credits when purchasing coverage via an exchange.
4. PPACA fees: Patient-Centered Outcome Research Institute Fees (“PCORI Fees”) must be paid in July 2013 (that’s now!). The first Transitional Reinsurance Fee must be paid on or before Jan. 15, 2015. PCORI is a private non-profit corporation that gathers research-based information to assist patients, practitioners and policy makers in making informed health care decision.
5. W-2 reporting: Employers must continue to report the aggregate value of health coverage on Forms W-2.
6. Counting Period for Employer Mandate: Employers that need to determine whether they will be subject to the employer mandate in 2015 (50 or more full-time or full-time equivalent employees in 2014) will need to record employee hours in 2014. It is not yet clear whether a short counting period will be available, which means that employers may be smartest to begin to track hours on a per-employee, monthly basis on Jan. 1.
7. Benefit Mandates For All Plans: Plan design requirements for all plans continue to apply (e.g., maximum 90-day waiting period, no limits on pre-existing conditions or essential health benefits, expansion of wellness incentives, dependent coverage to age 26).
8. Benefit Mandates for Non-Grandfathered Plans Only: Plan design requirements for non-grandfathered plans only continue to apply (e.g., preventive care coverage requirements, limits on out-of-pocket maximums, coverage for clinical trial-related services, and provider nondiscrimination, and for small group health plans, limits on annual deductibles).