ACA
As required under the ACA, the federal government must conduct audits of Marketplace coverage to ensure that only people who are truly eligible are receiving a subsidized plan.
Effective Spring 2016, CMS launched an "Employer Initiatives" Program to aid in the auditing process. As part of this program, CMS may contact an employer to request whether or not one or more employees were enrolled in minimum essential coverage, or whether or not they were offered a health plan which was affordable and had minimum value.
Since the Affordable Care Act (ACA) took effect, Flex has been following closely as the market transitions further away from traditional healthcare concepts. The following is the first piece in a three-part series that addresses key industry issues, trends and solutions related to Consumer-Driven Accounts (CDAs).
Whether it be the ACA, COBRA, ERISA, HIPAA, Section 125, or another regulation, employers can find themselves out of compliance somehow, and they may not even be aware. Here is a list of some common areas of non-compliance, not ranked in any particular order.
Posted March 18th, 2016 in Producers, Employers, Individuals
We can categorize health insurance plans in a number of different ways. There are fully-insured and self-insured plans, HMOs and PPOs, high deductibles and low deductibles, and metallic tiers (bronze, silver, gold and platinum) which are used in some market segments. There’s also one other way to categorize health insurance plans, and that’s by their “grandparent” status. The grandparent status determines which Affordable Care Act (ACA) rules a health insurance plan must comply with.
Grandfathered Plans
Posted March 11th, 2016 in Producers, Employers, Individuals
Each year the Department of Health and Human Services (HHS) issues a set of rules referred to as the “Notice of Benefit and Payment Parameters.” This set of rules generally addresses changes and new requirements that apply to certain provisions of the Affordable Care Act (ACA).
Posted February 26th, 2016 in Producers, Employers, Individuals
The Centers for Medicare and Medicaid Services (CMS) recently announced a new process that will impact anyone seeking to enroll with a special enrollment period (SEP) on the Healthcare.gov website. Under the current process, individuals who experience a qualifying event simply need to check a box on the application to be eligible for an SEP.
Posted February 12th, 2016 in Producers, Employers, Individuals
In most instances an employer can no longer pay or reimburse employees with pre-tax dollars for health coverage that is obtained in the individual market. The Department of Labor (DOL) recently issued Technical Release 2016-1 in relation to how this rule impacts student health plans.
Posted January 29th, 2016 in Producers, Employers, Individuals
Insurance companies are concerned that some people are abusing the Special Enrollment Period (SEP) that is available in the individual marketplace. They have indicated at least some people are delaying enrollment in coverage until they get sick, applying for coverage only once they need it, and then canceling the coverage after treatment. They further argue that there aren’t enough rules in place to verify if a person actually experienced a qualifying event which would trigger a SEP.
The Internal Revenue Service (IRS) recently issued Notice 2016-4 which extends the deadlines to complete the new Affordable Care Act (ACA) reporting requirements. The reporting is used to help the IRS enforce the Individual and Employer Mandates, and it’s also used to help the IRS administer subsidies in the Exchange. It applies to insurers and certain employers effective for the 2015 calendar year and moving forward. The new deadlines are as follows:
Posted December 23rd, 2015 in Producers, Employers, Individuals
You may have heard that President Obama recently signed into law the Consolidated Appropriations Act of 2016, a $1.1 trillion spending bill, avoiding a shutdown and funding the federal government through September 30, 2016. The President also signed the Protecting Americans from Tax Hikes (PATH) Act of 2015 which provides nearly $700 billion in tax breaks. Here’s what it means to the Affordable Care Act (ACA) and transit reimbursement plans.
Cadillac Tax
- The Cadillac Tax has been delayed by two years until 2020.
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