The proposed legislation would repeal the individual and employer mandates back to the beginning of 2016, increase the contribution limits for Health Savings Account, and eliminate many of the taxes created to pay for the Affordable Care Act. Read the bill and an eight-page summary here.
Among other things, the 21st Century Cures Act legalizes “defined contribution” for individual plans through a qualified small employer health reimbursement arrangement for non-applicable large employers. Below is the language from that part of the legislation.
This set of FAQs addresses coverage of preventive services under the Affordable Care Act and the Mental Health Parity and Addiction Equity Act.
This set of FAQs addresses premium reduction arrangements for student health plan coverage.
This set of FAQs addresses notice of coverage options – COBRA and the Health Insurance Marketplace.
This set of FAQs addresses coverage of preventive services, rescissions, out-of-network emergency services, coverage for individuals participating in approved clinical trials, limitations on cost-sharing under the Affordable Care Act, the Mental Health Parity and Addiction Equity Act and the Women’s Health and Cancer Rights Act.
This set of FAQs addresses the summary of benefits and coverage (SBC).
The Affordable Care Act requires plans and issuers that offer dependent coverage to make the coverage available until the adult child reaches the age of 26, even if the young adult no longer lives with his or her parents, is not a dependent on a parent’s tax return, or is no longer a student, is married, or has another offer of employer-based coverage (through his or her own job).
The employer shared responsibility provisions, found in section 4980H of the Internal Revenue Code, says that an applicable large employer (one with 50 or more full-time equivalent employees) must offer minimum essential coverage that is both affordable and provides minimum value to its full-time employees or face a tax penalty.
The Affordable Care Act ensures Americans have access to quality, affordable health insurance. To achieve this goal, the law ensures that health plans offered in the individual and small group markets, both inside and outside of Health Insurance Marketplaces, offer a core package of items and services, known as “essential health benefits.” There are 10 categories of essential benefits that must be covered, and additional essential benefits are added in each state depending on the reference plan selected.
Section 1512 of the Affordable Care Act creates a new Fair Labor Standards Act (FLSA) section 18B requiring a notice to employees of coverage options available through the Marketplace. The “Notice of Coverage Options” must be provided to all employees, whether eligible for group health coverage or not, within 14 days from their date of hire.
Before and after the passage of the Affordable Care Act, President Obama has repeatedly said “if you like your health plan, you can keep it”. Though it was misunderstood by many consumers, media outlets, and even our elected officials, there is a provision in the law that allows plans that were in place when the law was signed on March 23rd, 2010 to be “grandfathered” and avoid many of the new market rules, most of which went into effect on the plan’s renewal date in 2014.
One of the most important components of the Affordable Care Act is the Health Insurance Marketplace, originally called the Exchange. The Marketplace is an online shopping portal that allows consumers to shop for qualified plans and to apply for financial assistance in the form of premium tax credits and cost-sharing subsidies.
Starting in 2014, Section 5000A of the Affordable Care Act — the Individual Shared Responsibility provision — calls for each individual to either have minimum essential coverage for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return.
Beginning in 2011, the law requires insurance companies in the individual and small group markets to spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities. Insurance companies in the large group market must spend at least 85 percent of premium dollars on medical care and quality improvement activities. Insurance companies that do not meet the MLR standard will be required to provide rebates to their consumers.
Multiple Employer Welfare Arrangements (MEWAs) are established for the purpose of offering health coverage and other benefits to the employees of two or more employers (including self-employed individuals). MEWAs are typically marketed to small employers as a low-cost alternative to traditional forms of health insurance. The Affordable Care Act amended ERISA to require MEWAs to register with the Secretary prior to operating in a State.
To avoid shared responsibility penalties under section 4980(b) of the tax code, applicable large employers must provide minimum essential coverage that is both affordable and provides minimum value. Generally, a minimum value plan is one with an actuarial value of at least 60% and provide hospitalization coverage.
PHS Act section 2708 provides that, for plan years beginning on or after January 1, 2014, a group health plan or health insurance issuer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days, though there can be a reasonable orientation period before the waiting period begins. The new hire waiting period is different from the limited non-assessment period under the employer mandate.
Section 10101(d) of the Affordable Care Act adds § 2716 to the PHS Act, which provides that a group health plan (other than a self-insured plan) must satisfy the substantive nondiscrimination requirements of § 105(h)(2) of the IRS Code. The Departments have determined that compliance with § 2716 should not be required (and thus, any sanctions for failure to comply do not apply) until after regulations or other administrative guidance of general applicability has been issued under § 2716, and those have not yet been issued.
The Patient Protection and Affordable Care Act created a number of new patient protections, many of which became effective with the first renewal on or after September 23, 2010. Other patient protections become effective on the plan’s first renewal date in 2014. Some of these changes are grandfathered, meaning that a plan in effect on March 23, 2010 does not have to implement them, while others are non-grandfathered and must be included in all plans.
Section 2713 of the Public Health Service Act, as added by the Patient Protection and Affordable Care Act, requires coverage without cost sharing of certain preventive health services, including certain contraceptive services, in non-exempt, nongrandfathered group health plans and health insurance coverage. This requirement was effective for non-grandfathered plans with the first renewal on or after September 23, 2010.
This Affordable Care Act creates a tax credit to help small businesses and small tax-exempt organizations afford the cost of covering their employees and is specifically targeted for those with low- and moderate-income workers. The credit is designed to encourage small employers to offer health insurance coverage for the first time or maintain coverage they already have. While not very popular, companies with up to 25 EEs and $50k in wages can get a tax credit.
requires all group health plans and health insurance issuers offering group health insurance coverage to provide applicants, enrollees, and policyholders or certificate holders with a summary of benefits and coverage that “accurately describes the benefits and coverage under the applicable plan or coverage.” Willful failure to provide the information required under this section can result in a $1,000 fine plus a separate fine for each individual or entity for whom there is a failure to provide an SBC.
The Affordable Care Act creates new incentives and builds on existing wellness program policies to promote employer wellness programs and encourage opportunities to support healthier workplaces. The law increases the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20 percent to 30 percent of the cost of coverage and up to 50 percent for wellness programs designed to prevent or reduce tobacco use.
This set of FAQs addresses coverage of preventive services, wellness programs, and the Mental Health Parity and Addiction Equity Act of 2008.
This set of FAQs addresses transparency reporting for non-QHP issuers and non-grandfathered group health plans.
This set of FAQs addresses limitations on cost sharing and provider non-discrimination.
This set of FAQs addresses coverage of preventive services.
This set of FAQs addresses the wellness program requirements.
This set of FAQs addresses proposed changes to the SBC regulations, as well as a new SBC template and associated documents.
This set of FAQs addresses excepted benefits.
On Feb. 10, 2014, the IRS and Treasury issued final regulations on the Employer Shared Responsibility provisions under section 4980H of the Internal Revenue Code. These questions and answers provide helpful information about the guidance.
These FAQs provide detailed information about completing Form 1094-C and Form 1095-C.
Information reporting under section 6055 is voluntary for calendar year 2014. Reporting is first required in early 2016 for calendar year 2015.
Information reporting under section 6056 is voluntary for calendar year 2014. Reporting is first required in early 2016 with respect to calendar year 2015.
This set of FAQs addresses compliance of premium reimbursement arrangements.
This set of FAQs addresses limitations on cost-sharing under the ACA.
This set of FAQs addresses coverage of preventive services.
New research trust fund fees are due July 31 from health insurers and the plan sponsors of self-insured plans. The fee is paid annually using Form 720, Quarterly Federal Excise Tax Return. The payment, paid through the Electronic Federal Tax Payment System (EFTPS), should be applied to the second quarter (in EFTPS, select Q2 for the Quarter under Tax Period on the “Business Tax Payment” page).
This FAQ explains the potential penalty an employer that pays for or reimburses employees for individual health insurance premiums could face.
This set of FAQs addresses updated DOL model notices, limitations on cost-sharing, coverage of preventive services, health FSA carryover and excepted benefits, and the Summary of Benefits and Coverage requirements of PHS Act §2715. (Note: Some of the guidance in FAQs Parts VIII, IX, and X has been superseded by guidance contained in FAQs Part XIV and some of the guidance in FAQs Parts VIII, IX, X, and XIV has been superseded by guidance contained in FAQs Part XIX.)
This set of FAQs addresses coverage of preventive services, limitations on cost-sharing, expatriate health plans, wellness programs, fixed indemnity insurance, and the Mental Health Parity and Addiction Equity Act of 2008.
Federal law gives a tax credit to eligible small employers who provide health care coverage to their employees. These questions and answers provide information on the credit for tax years beginning in 2014.
Effective January 1, 2014, individuals and families with incomes up to 400% of the Federal Poverty Level may qualify for advance premium tax credits to help them pay for qualified health insurance purchased through a state or federal marketplace.
The Affordable Care Act increases the minimum threshold to deduct medical expenses for those who itemize their deductions on their federal income tax return.
Effective January 1, 2014, most Americans are required to have health insurance or pay a penalty. This is frequently referred to as the Individual Mandate. The first penalties will be filed when people file their 2014 taxes in early- to mid-2015.
On Nov. 26, 2013, the IRS issued final regulations (TD 9645) implementing the Additional Medicare Tax as added by the Affordable Care Act (ACA). The Additional Medicare Tax applies to wages, railroad retirement (RRTA) compensation, and self-employment income over certain thresholds. Employers are responsible for withholding the tax on wages and RRTA compensation in certain circumstances.
This set of FAQs addresses the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the Affordable Care Act.
This set of FAQs addresses the employer notice of coverage options and the 90-day waiting period limitation.
This set of FAQs addresses annual limit waiver expiration date based on a change to a plan or policy year, provider non-discrimination, coverage for individuals participating in approved clinical trials and transparency reporting.
This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715. (*Note: Some of the guidance in FAQs Parts VIII, IX, and X has been superseded by guidance contained in FAQs Part XIV and some of the guidance in FAQs Parts VIII, IX, X, and XIV has been superseded by guidance contained in FAQs Part XIX.)
This set of FAQs addresses expatriate health plans.
This set of FAQs addresses preventive services and limitations on cost-sharing under the ACA.
This set of FAQs addresses the employer notice of coverage options, health reimbursement arrangements, disclosure of information related to firearms, employer group waiver plans supplementing Medicare Part D, fixed indemnity insurance and payment of PCORI fees.
Effective Jan. 1, 2013, individual taxpayers are liable for a 3.8 percent Net Investment Income Tax on the lesser of their net investment income, or the amount by which their modified adjusted gross income exceeds the statutory threshold amount based on their filing status.
This FAQ addresses the Summary of Benefits and Coverage requirements of PHS Act §2715. (Note: Some of the guidance in FAQs Parts VIII, IX, and X has been superseded by guidance contained in FAQs Part XIV and some of the guidance in FAQs Parts VIII, IX, X, and XIV has been superseded by guidance contained in FAQs Part XIX.)
This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715. (Note: Some of the guidance in FAQs Parts VIII, IX, and X has been superseded by guidance contained in FAQs Part XIV and some of the guidance in FAQs Parts VIII, IX, X, and XIV has been superseded by guidance contained in FAQs Part XIX.)
This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715. (Note: Some of the guidance in FAQs Parts VIII, IX, and X has been superseded by guidance contained in FAQs Part XIV and some of the guidance in FAQs Parts VIII, IX, X, and XIV has been superseded by guidance contained in FAQs Part XIX.)
This set of questions and answers provides information for employers on reporting the cost of the health insurance coverage, including information on transition relief for 2012, how to report, which coverage to include, and how to determine the cost of the coverage.
This set of FAQs addresses the Summary of Benefits and Coverage and Uniform Glossary requirements of PHS Act §2715 and the Mental Health Parity and Addiction Equity Act of 2008.
This set of FAQs addresses grandfathered health plans.
As of January 1, 2011, over-the-counter drugs purchased without a prescription are no longer an eligible expense under an FSA, HRA, or HSA.
This set of FAQs addresses a variety of ACA implementation topics, the HIPAA nondiscrimination and wellness program rules, and the Mental Health Parity and Addiction Equity Act of 2008.
This set of FAQs addresses grandfathered health plans.
This set of FAQs addresses the exemption for group health plans with less than two current employees.
This set of FAQs addresses grandfathered health plans, dental and vision benefits, rescissions, preventive health services, and ACA effective date for individual health insurance policies.
This set of FAQs addresses implementation topics including compliance, grandfathered health plans, claims, internal appeals and external review, dependent coverage of children, out-of-network emergency services, and highly compensated employees.
The Affordable Care Act is the common name for the 2,409 page Patient Protection and Affordable Care Act as amended by the 55 page Health Care and Education Reconciliation Act of 2010, signed into law by President Obama on March 23, 2010. Together, this legislation makes the most significant changes to the health care financing system since Medicare was passed in 1965. Read the law as it was written by Congress.