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Tired of the Health Care Hullabaloo?

April 1, 2016

Authors

benefitsbclp

Tired of the Health Care Hullabaloo?

April 1, 2016

by: benefitsbclp

Hullabaloo: noun: a commotion, a fuss.

In recent years, almost every change to health care has caused a hullabaloo. Today, we thought you might enjoy reading about a few recent and proposed changes that, although important, have not caused quite the uproar to which we have become accustomed.

The Department of Health and Human Services has finalized the annual in-network out-of-pocket maximums for non-grandfathered health plans for 2017:

An enrollee in self-only coverage may not pay more than $6,850 for essential health benefits in 2016; for 2017, that number has increased to $7,150.

An enrollee in any coverage other than self-only may not pay more than $13,700 for essential health benefits in 2016; for 2017, that number has increased to $14,300.

Section 1411 of the Patient Protection and Affordable Care Act requires federally facilitated marketplaces (but not state facilitated marketplaces) to provide notice to employers when

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Health Care Reform: Where are We Now that ACA’s Employer Mandate Has Been Delayed for One Year?

July 10, 2013

Authors

Lisa Van Fleet

Health Care Reform: Where are We Now that ACA’s Employer Mandate Has Been Delayed for One Year?

July 10, 2013

by: Lisa Van Fleet

The Benefits world was rocked last week when it was announced that enforcement of the ACA employer shared responsibility penalties would be delayed for one-year. IRS Notice 2013-45, released late yesterday, July 9, officially confirmed the delay, but provided no real additional guidance.  Employers are asking, what exactly this means?  Read on for our summary of where things stand.

I.     What ACA requirements are delayed in 2014?

  • Employer Mandate:  Employers must offer coverage to employees who work on average 30+ hours per week.
  • Affordability:  Coverage must be affordable (i.e., the employee’s share of the coverage cost cannot exceed 9.5% of the employee’s household income).
  • Minimum Value:  Coverage must provide minimum value (although this requirement is waived, employer must still report whether a plan provides minimum value on the SBC).
  • Certain Reporting Requirements:  Employers (and insurers) must provide information
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SBCs: Few Changes and (Mostly) Extended Relief

April 29, 2013

Authors

Chris Rylands and Lisa Van Fleet

SBCs: Few Changes and (Mostly) Extended Relief

April 29, 2013

by: Chris Rylands and Lisa Van Fleet

On Tuesday, the PPACA triumvirate of DOL, Treasury/IRS and HHS issued a new set of FAQs (number 14, for those still counting) covering changes to the Summary of Benefits and Coverage.  The only changes (as emphasized in multiple places in the FAQs) are to add two disclosures:

– Whether the plan provides “minimum essential coverage” (or MEC)

– Whether the plan meets, or does not meet, the “minimum value” requirements.

MEC, simply put, is an employer-sponsored plan that complies with health care reform (whether or not its grandfathered).  Minimum value (which is also relevant for play or pay purposes) generally means that the plan’s share of the total allowed costs of benefits provided under the plan or coverage is not less than 60 percent of such costs.

The agencies released templates in both Word and PDF showing how this is done (as well as blank

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Does Your EAP or Wellness Program Need a Summary of Benefits and Coverage?

May 30, 2012

Authors

benefitsbclp

Does Your EAP or Wellness Program Need a Summary of Benefits and Coverage?

May 30, 2012

by: benefitsbclp

Even though health reform’s legal status is up in the air, plan sponsors are still taking cautious steps forward to make sure they are ready if it survives the Supreme Court challenge. One of those steps, which is coming soon, is the Summary of Benefits and Coverage requirement, which has to be initially provided for the first open enrollment period beginning on or after September 23, 2012.

Many plan sponsors mistakenly assume that their employee assistance programs (EAPs) or wellness programs are not subject to these requirements. However, as we discussed in our post on W-2 reporting of health coverage, EAPs that provide counseling (even for only a few sessions) and wellness programs that provide medical care are technically group health plans under ERISA. Among other implications, this means they are subject to SBC requirements.

That said, plan sponsors do have some structuring alternatives

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