24 Hour ACA Extension - Sort Of

Monday December 23rd, 2013 is the last day to sign up for health insurance on the federal exchange for coverage that starts Jan. 1, but government techies have built in a little wiggle room.

People have until midnight tonight to get started. But just to be safe, the administration has sneaked in an extra 24-hour buffer, the Washington Post first reported, giving people until midnight Tuesday night to get enrolled if they start the process by midnight Monday.

Remember when enrolling online, please be sure to include us as your Broker so we can be of further assistance in the future:

Brenda D. Cutting
National Producer Number (NPN) = 6998229
Federally-Facilitated Marketplaces (FFM) ID = bcutting

Happy Holidays!

Statement of the Virginia Bureau of Insurance Regarding Extension of Individual and Small Group Health Insurance Plans

Virginia regulators say they may not have legal authority to require insurers to extend cancelled health policies as long as two years, as President Barack Obama requested last week.

The Bureau of Insurance instead asked insurance carriers today to give individual and small group market customers the option of renewing their existing policies early to extend coverage into 2014, as insurers already have done in many cases for people with policies that do not comply with higher standards under the Affordable Care Act.

HealthCare.gov won't be fixed by end of the month

The Washington Post is reporting that an official with knowledge of the technological demands on the government's online health insurance marketplace says it is not likely the site will be fully functional by the end of the month, as the Obama administration has promised.

Regulatory change affecting Individual and Small Group business announced by President Obama

On 11/14/2013, President Obama announced that insurers may renew certain individual and small group health plans for 2014 without having to comply with new Affordable Care Act (ACA) requirements scheduled to take effect on January 1, 2014. Eligible policies include those with an effective date between January 1 and October 1, 2014 that would have otherwise been terminated.

Individual mandate penalty delayed

The part of the Affordable Care Act (ACA or health care reform law) with the biggest impact – the individual mandate – is getting a lot of attention lately. Under the law and regulation as written, people who buy health insurance as individuals (an individual plan) can go three months without health insurance and not have to pay the individual mandate penalty. Now that individual market open enrollment goes until March 31, 2014, coverage can start as late as May 1. The Obama Administration felt like it needed to fix the problem where someone who buys insurance in the last 45 days of open enrollment still would have ended up paying part of the penalty. Because of a change to the regulation this week, this will no longer be the case in 2014. As long as people buying individual plans are signed up for insurance by March 31, 2014, they will not get hit with the penalty.

The Centers for Medicare and Medicaid Services put out guidance on October 28 that gives more information on the “hardship exemptions” for the individual mandate penalty. The Department of Health and Human Services is putting such an exemption in place for people who sign up for insurance before the open enrollment period ends on March 31, 2014. Without this exemption, individuals would have had to be covered by health insurance by March 31, meaning they would have had to sign up for it by February 15, 2014. Now, people who have signed up by March 31 will be able to claim a “hardship exemption” (without asking for it from the marketplace) on their taxes and not pay the penalty for the months in 2014 that they did not have health insurance.

Treasury modifies "use-it-or-lose-it" provision to allow a limited rollover of Health FSA funds

On 10/31/2013, the Department of Treasury issued a press release and informational fact sheet announcing a major policy change relating to flexible spending accounts (FSAs) that has many positive implications for all FSA employers and participants. The Department of Treasury has modified its FSA “use-it-or-lose-it” provision to allow a limited rollover of FSA funds (up to $500).

 

Details are as follows:

Here's Why So Many Americans Are Getting Letters Saying Their Health Insurance Is Canceled

"If you like your health care plan, you can keep your health care plan." This was one of President Obama's key talking points when selling the Affordable Care Act, and it was never true — as many of the 14 million Americans currently covered by individually-purchased health plans are now learning.

As Kaiser Health News reports, individual market insurers are sending out rafts of cancellation notices, telling subscribers they have to change to new plans starting in 2014. Here's why:

Top 4 Obamacare Complaints

The debut of the Obamacare health insurance exchanges has been anything but smooth.

Three weeks after the exchanges opened, Americans are still having a tough time signing onto the Obamacare websites. And once they manage to get in, many aren't so happy with what they're finding.

Subsidy Calculator - Premium Assistance for Coverage in Exchanges

This tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). Beginning in October 2013, middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies available through state-based exchanges.

Take a deep breath....

Today at 8 a.m. ET the Marketplace opened for the very first time. There have been technical difficulties, glitches, delays, and at times, it has gone down completely. Today is just the first day, take a deep breath, let the dust settle, and remember that we are here to help you. The Open Enrollment Period is October 1, 2013–March 31, 2014.  As long as you enroll by December 15, 2013 and make your first premium payment, your new health coverage will be effective January 1, 2014.

Since March 23, 2010 when the Affordable Care Act (ACA) was passed into law, we have all been on a journey to understand how the law will impact each of us. This is still true today as we continue to work through final regulations and the opening of the Marketplace. However, one element of the law is clear. Health care reform does nothing to sever the Client / Broker relationship and our ability to help you. Under ACA, Sterling Benefits, LLC will continue to be able to advise and assist clients with their benefit needs as we move into 2014.

As acknowledged by President Obama, ACA is complex and the implementation will be "bumpy".  Some of you may be able to access government subsidies to help obtain quality health insurance at affordable rates. Others will continue to access health care from their current method. Health care reform will change many aspects of our current system but it will not affect our ability as a Broker to work on your behalf.  We want to assure you we are Marketplace Certified and will be able to provide all of our clients with the help needed to find the best solution for your specific situation.

Thank you for the opportunity to be of service.

Sincerely,
Christina & Brenda

Brenda D. Cutting
National Producer Number (NPN) = 6998229
Federally-Facilitated Marketplaces (FFM) ID = bcutting

Christina M. Brunner
National Producer Number (NPN) = 8659135
Federally-Facilitated Marketplaces (FFM) ID = cbrunner

Homework involved to apply for health insurance

Article from the AP:

WASHINGTON (AP) -- Getting covered under President Barack Obama's health care law might take you more than one sitting. In a media preview, it felt like a cross between doing your taxes and making an important purchase that requires research.

"Nothing like this has ever existed before," said Health and Human Services Secretary Kathleen Sebelius.

You'll need accurate income information for your household, plus some understanding of how health insurance works, so you can get the financial assistance you qualify for and pick a health plan that's right for your needs.

Things to Know About Health Insurance Today

Today begins the biggest expansion of health insurance since Medicare. According to the Congressional Budget Office (PDF), an estimated 7 million Americans will buy private health plans through the new online marketplaces known as insurance exchanges, which are now opening nationwide. That number is expected to more than triple in the years ahead.

 

It could be a bumpy launch, with technical problems and public confusion.

 

Here are 10 things you need to know about the insurance exchange program:

Animation Explains Changes Coming for Americans Under the Affordable Care Act

2014 is coming--are you ready for Obamacare? Join the YouToons as they walk through the basic changes in the way Americans will get health coverage and what it will cost starting in 2014, when major parts of the Affordable Care Act, also known as "Obamacare," go into effect.

Courtesy: The Henry J. Kaiser Family Foundation.

HHS Releases a Report of Health Insurance Marketplace Premiums for 2014

HHS released a report that summarizes the health plan choices and premiums that will be available in the Health Insurance Marketplace. It contains new information, current as of September 18, 2013, on qualified health plans in the 36 states in which the Department of Health and Human Services (HHS) will support or fully run the Health Insurance Marketplace in 2014. Plan data is in final stages but is still under review as of September 18 and may be revised in HHS systems before being displayed for consumers, so this information is subject to change. 

Online enrollment for federal SHOP will be delayed

In the latest setback for the rollout of Obamacare, the U.S. Department of Health and Human Services announced Thursday that small businesses in 36 states can’t enroll their workers into health coverage through the new federally run insurance marketplaces until at least Nov. 1 – one month later than previously announced.

The delay appears to be the result of computer and information technology problems in the Small Business Health Option Program, known as SHOP, an online insurance marketplace specifically for small employers.

Employers still will be able to compare coverage options and begin the application process on Oct. 1, but they won’t be able to sign up workers for coverage until November.

Explanation of Guidance on HRAs, Health FSA- Clarification?

It appears that the pre-tax reimbursement of individual premiums under a premium only plan (POP) (under Code Section 125) is directly at odds with the prohibition against any annual limit on the dollar amount of essential health benefits under the Affordable Care Act (Act). 

On Friday, September 13, the Departments of Labor, Treasury and Health and Human Services provided guidance on the application of certain provisions of the Affordable Care Act (Act) on health reimbursement arrangements (HRAs), certain health flexible spending arrangements (Health FSAs) and employee assistance programs (EAPs). It was clear from the initial reading of the guidance that individual premiums could not reimbursed by HRAs. In a further reading of the guidance, there appears to be more serious consequences.
 

FTC Alert: Scammers Out to Trick Consumers Using Affordable Care Act

No sooner had the U.S. Supreme Court ruled on the Affordable Care Act than scam artists began working the phones. They say they're from the government and that, using the Affordable Care Act as a hook, they need to verify some information. They might have the routing number from your bank, and then use that information to get you to reveal the entire account number. Or, they'll ask for your credit card or Social Security number, Medicare ID, or other personal information.

 

The Federal Trade Commission, the nation's consumer protection agency, advises consumers not to give out personal or financial information in response to unsolicited phone calls, emails, or knocks on your door. Scam artists want your information to commit identity theft, charge your existing credit cards, debit your checking account, open new credit card, checking, or savings accounts, write fraudulent checks, or take out loans in your name.

  

To avoid scams related to ACA implementation:

DOL Releases Guidance on HRAs, Health FSAs and Certain Other Employer Healthcare Arrangement Options

On Friday, September 13, 2013, the DOL and the IRS issued guidance on how the annual limit and preventive services rules in the Affordable Care Act (ACA) apply to HRAs.

IRS Notice 2013-54 and DOL Technical Release 2013-03 provided much-awaited answers to questions about what types of HRAs comply with these ACA rules. The guidance also addressed Employee Assistance Programs (EAPs). The Notice and Technical Release mirror each other. The guidance applies to plan years starting on or after January 1, 2014. Additional regulatory guidance will be forthcoming.

DOL FAQ on Notice of Coverage Options

Q: Can an employer be fined for failing to provide employees with notice about the Affordable Care Act's new Health Insurance Marketplace?

A: No. If your company is covered by the Fair Labor Standards Act, it should provide a written notice to its employees about the Health Insurance Marketplace by October 1, 2013, but there is no fine or penalty under the law for failing to provide the notice.
http://www.dol.gov/ebsa/faqs/faq-noticeofcoverageoptions.html

Dear seniors, your Medicare benefits aren't changing under the Affordable Care Act

Dear seniors, your Medicare benefits aren't changing under the Affordable Care Act. That's the message federal health officials are trying to get out to elderly consumers confused by overlapping enrollment periods for Medicare and so-called "Obamacare."

Medicare beneficiaries don't have to do anything differently. Medicare open enrollment starts Oct. 15 and closes Dec. 7, while enrollment for the new state exchanges for people 65 and under launches Oct. 1 and runs through March. 

Next month, roughly 50 million Medicare beneficiaries will get a handbook in the mail with a prominent Q&A that stresses Medicare benefits aren't changing.

AP Article:  http://finance.yahoo.com/news/health-overhaul-confuses-medicare-beneficiaries-141050243.html. 

Health Insurance Exchange Notices Deadline 10/1/2013

As a reminder …

 

Notices about the health insurance exchanges have to be given to current workers no later than Oct. 1, 2013. Starting Oct. 1, the notices have to be given to new workers on the day they are hired. 　

 

The notices must:

1. tell workers about exchanges, including a description of the services provided and how they can contact exchanges;
2. let workers know they may be eligible for a premium tax credit if the employer plan’s does not cover at least 60% of the total allowed cost of benefits, and the worker buys a qualified health plan through an exchange;
3. explain that if the worker buys a qualified health plan through an exchange, he or she may lose the employer contribution (if any) to any health benefit plan the employer offers, and that all or part of the contribution may be excluded from income for federal tax purposes.

The notices (Exchange Model Notices (For Employers who offer a health plan and Employers who do not offer a health plan) and the Revised Model COBRA Election Notice), along with further guidance, can be found at www.dol.gov/ebsa. Please review the attached Health Care Reform Hot Topic for more information on the Model Notices Explanation.

COBRA and the ACA: Compatible or Irreconcilable?

Several key provisions of the Affordable Care Act (ACA) have now been delayed. When the ACA has fully achieved lift off, what will become of COBRA?

 

The simple answer is that COBRA will continue to fly, until and unless another law permanently grounds it. Here are some observations around the interplay between the ACA and COBRA:

• The ACA likes COBRA. Parts of the ACA looked to COBRA concepts as the gold standard for calculations. Case in point is W-2 reporting of health care coverage in IRS Notice 2012-09. More recently, the DOL thought COBRA was important enough to update the Model Election Notice when it released the Exchange Notice. Click here for our article.
• The DOL likes COBRA. Look at this DOL FAQ, which states that the ACA “did not eliminate COBRA or change the COBRA rules.” making it clear that COBRA is not going away. And take a gander at this lengthy 25-year proclamation by the DOL from 2011.
• COBRA fills some ACA gaps. Granted, the Health Insurance Marketplace will provide COBRA qualified beneficiaries with some alternatives for medical coverage. In some cases, the alternatives may be cheaper, but that is not certain. Also, understand that stand-alone dental, vision, prescription drugs are not required to be offered in the marketplace. Neither are flexible benefits like HRAs and Health FSAs. COBRA offers these benefits to the extent that they are employer-sponsored coverage.
• To some extent, the marketplace likes COBRA. To some extent, the Marketplace coordinates with COBRA. For example, take your most common reason for termination of COBRA: premium non-payment. If a qualified beneficiary loses coverage because of non-payment, this person is not entitled to a special enrollment period for Marketplace coverage and must wait until the annual enrollment period. Another thing to consider is when the Marketplace opens in 2014, small employers can obtain Marketplace coverage through the Small Business Health Options Program (SHOP). This coverage would be subject to COBRA because it is employer-sponsored coverage.

 

This is COBRA’s current status: a valid law. The ACA did not change COBRA, as the DOL has pointed out.

 

COBRA and the ACA: Compatible or Irreconcilable? | Infinisource Newsroom

Health Care Reform & Group Imposed Waiting Periods for group insurance coverage

The Patient Protection and Affordable Care Act (PPACA) provides that for plan years beginning on or after Jan. 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. A waiting period is defined by the Public Health Service Act as a “period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll under the terms of a group health plan can become effective.”

An employer whose waiting period exceeds 90 days may be subject to penalties under Code 4980H, beginning in 2014, for every month the employer does not offer coverage if any employee obtains coverage through an exchange and is eligible for a premium tax subsidy.

Some employer plans provide that employees will become eligible for insurance coverage on the first of the month after 90 days (or longer). IRS guidance indicates that this plan design is not acceptable as it would typically exceed the 90-day limit. In these circumstances, employers would need to change their eligibility to the first of the month after 60 days or any other shorter waiting period that does not exceed 90 days to avoid penalties.

Employer mandate delay, minimum value, out-of-pocket maximum cost sharing: Is there a connection?

Recent headlines from certain news outlets are leading some to think that the out-of-pocket maximum and minimum value plan certification parts of the Affordable Care Act (ACA, or health care reform law) have been delayed until 2015. This is not true. The delay is for combining a shared out-of-pocket maximum for plans that have “multiple service providers” (like a separate pharmacy benefits manager). Medical plans, new and renewing January 1, 2014, and later do need to have out-of-pocket maximums that are not more than $6,350 for single coverage and $12,700 for coverage of spouse or family. Our plans and systems are being updated so that cost shares do not go over the out-of-pocket maximum.

To help sort out the facts from fiction, read this fact sheet that tells what the link is among the employer mandate, the parts that were delayed, the minimum value plan certification requirement and the out-of-pocket maximum cost sharing rule.

Article Courtesy:  Anthem BCBS

A Limit on Consumer Costs is Delayed in Health Care Law

New York Times
WASHINGTON - In another setback for President Obama's health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.

The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.

The grace period has been outlined on the Labor Department's Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language - which appeared as an answer to one of 137 "frequently asked questions about Affordable Care Act implementation" - department officials confirmed the policy.

PCORI Fees & HRA's

Plan sponsors with calendar-year HRA plans must remit PCORI fees applicable for the 2012 plan year by July 31, 2013. 

For the July 1, 2013 payment deadline the fee is $1.00 per HRA-covered employee (dependents excluded).  Fees for plan years ending before 1/1/2013 are due by 7/31/2013.  If a plan ends after 1/1/2013 and before 10/1/2013, the fee is still $1.00, but not payable until 7/31/2014.

The Regulations indicate that the reporting and payment of PCORI fees cannot be delegated to your HRA TPA. The fees should be reported on Form 720 (Quarterly Federal Exercise Tax Return Form).

Please review the attached Health Care Reform Hot Topic for more information.

U.S. relaxes health law income - Health markets to employ honor system

As reported by the Washington Post:

The Obama administration announced Friday that it would significantly scale back the health law's requirements that new insurance marketplaces verify consumers' income and health insurance status.
Instead, the federal government will rely more heavily on consumers' self-reported information until 2015, when it plans to have stronger verification systems in place.

The delay comes after a Tuesday announcement that the federal government would postpone for one year a requirement that employers with 50 or more full-time workers provide health coverage.

"I think that Health and Human Services is doing the best that it can under the circumstances," said Sara Rosenbaum, a health policy professor at George Washington University.

The verification systems are meant to determine who qualifies for new benefits under the Affordable Care Act. The law includes tax subsidies to purchase health insurance for Americans who earn less than 400 percent of the poverty line, about $45,000 for an individual.

Those earning less than 133 percent of the poverty line - about $15,000 - will qualify for Medicaid coverage in the District and 23 states that have decided to expand the program.

The federal government also needs to know who receives health insurance coverage from an employer. Consumers who receive affordable health insurance from their company under a policy that costs less than 9.5 percent of their income do not qualify for tax credits under the Affordable Care Act.

Employer Mandate Delayed Until 2015

Bloomberg: Health-Law Employer Mandate Said to Be Delayed to 2015
Businesses won't be penalized next year if they don't provide workers health insurance after the Obama administration decided to delay a key requirement under its health-care law, two administration officials said. The decision will come in regulatory guidance to be issued later this week. It addresses vehement complaints from employer groups about the administrative burden of reporting requirements, though it may also affect coverage provided to some workers (Dorning and Wayne, 7/2).

The Washington Post: White House Delays Employer Mandate Requirement Until 2015  The Obama administration will not penalize businesses that do not provide health insurance in 2014, the Treasury Department announced Tuesday. Instead, it will delay enforcement of a major Affordable Care Act requirement that all employers with more than 50 employees provide coverage to their workers until 2015 (Kliff, 7/2).

What’s not changing as a result of these delays:

• The Exchanges/Marketplaces
• The individual mandate
• Individuals’ access to premium tax credits
• Any other PPACA provision

Here is the announcement by the Treasury Department made on 7/2/2013: http://www.treasury.gov/connect/blog/Pages/Continuing-to-Implement-the-ACA-in-a-Careful-Thoughtful-Manner-.aspx.

Please review the attached Health Care Reform Hot Topic for more information.

Young Americans may dodge health law; For 20-somethings, penalty may be preferable to buying insurance

Young Americans may have been among the biggest supporters of Obamacare, but they may also be the least likely to comply with the law.

The architects of health reform say the law will make insurance more affordable and widely available. But in 2014, benefits experts say, the cheapest option for 20-somethings will be to pay the penalty for not buying health insurance, rather than paying for any health insurance at all—that is, provided they don’t get sick.

And as more young people do the math, more seem to be deciding the Affordable Care Act isn’t such a good deal for them: Support for a national health-care plan dropped nearly 11% among American college freshmen between 2008 to 2012, with under 63% in favor of it today, down from 70%, according to UCLA’s annual student survey.

Next year, uninsured Americans must pay a penalty of $95, or 1% of their annual salary if they make more than $9,500 for the year. A person earning $50,000, for example, would pay a $500 penalty if they chose not to enroll in a health insurance plan.

HHS Launches Health Insurance Marketplace Educational Tools

The Obama administration kicked off the Health Insurance Marketplace education effort with a new, consumer-focused HealthCare.gov website and the 24-hours-a-day consumer call center to help Americans prepare for open enrollment and ultimately sign up for private health insurance. The new tools will help Americans understand their choices and select the coverage that best suits their needs when open enrollment in the new Health Insurance Marketplace begins October 1.

"The new website and toll-free number have a simple mission: to make sure every American who needs health coverage has the information they need to make choices that are right for themselves and their families-or their businesses," said Health and Human Services Secretary Kathleen Sebelius.

"The re-launched Healthcare.gov and new call center will help consumers prepare for the new coverage opportunities coming later this year," said Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner. "In October, HealthCare.gov will be the online destination for consumers to compare and enroll in affordable, qualified health plans."

HealthCare.gov is the destination for the Health Insurance Marketplace. Americans may now access new educational information and learn what they can do to begin to get ready for open enrollment this fall. The website will add functionality over the summer so that, by October, consumers will be able to create accounts, complete an online application, and shop for qualified health plans. For Spanish speaking consumers, CuidadoDeSalud.gov will also be updated to match HealthCare.gov's new consumer focus.

Key features of the website, based on consumer research and online commercial best practices include integration of social media, sharable content, and engagement destinations for consumers to get more information. The site will also launch with web chat functionality to support additional consumer inquiries.

The website is built with a responsive design so that consumers may access it from their desktops, smart-phones, and other mobile devices. In addition, the website is available via an application interface at www.healthcare.gov/developers.

Between now and the start of open enrollment, the Marketplace call center will provide educational information and, beginning Oct. 1, 2013, will assist consumers with application completion and plan selection. In addition to English and Spanish, the call center provides assistance in more than 150 languages through an interpretation and translation service. Customer service representatives are available for assistance via a toll-free number at 1-800-318-2596 and hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325 for assistance.
To view the new look and new focus of the website, visit www.HealthCare.gov.

Gov't Report: Smooth Launch Unsure for Health Law

There's no guarantee that President Barack Obama's health care law will launch smoothly and on time, congressional investigators say in the first in-depth independent look at its progress.
But in a report to be released Wednesday, the congressional Government Accountability Office also sees positive signs as the Oct. 1 deadline approaches for new health insurance markets called exchanges to open in each state - in many cases over the objections of Republican governors.

Additionally, the report discloses that the administration had spent nearly $400 million as of March to set up the infrastructure of a sprawling system involving major federal agencies, every state, hundreds of insurance companies, and millions of citizens, among them many individuals seeking coverage for the first time.

"Whether (the administration's) contingency planning will assure the timely and smooth implementation of the exchanges by Oct. 2013 cannot yet be determined," the report concluded. A copy was provided to The Associated Press.

IRS Determines that the PCOR Fees are Deductible Business Expenses

On May 31, 2013, the IRS released an update memorandum that found that fees paid by issuers of certain health insurance policies and plan sponsors of certain self-insured health plans to fund the Patient-Centered Outcomes Research Trust Fund (PCOR) were ordinary and necessary business expenses, and, thus, deductible business expenses under Section 4375-77 Excise Tax on Certain Insurance Policies.

To view the complete IRS Memo:  http://www.irs.gov/pub/irs-utl/AM2013-002.pdf

Final Rules on Employment Based Wellness Programs Released

On May 23, 2013, the DOL, Treasury and HHS finalized the HIPAA Nondiscriminatory Wellness Programs Regulations that were proposed in November 2012, clarifying what will work and what will not work for 2014 and beyond.

 

The accompanying news release stated that the “final rules ensure flexibility for employers by increasing the maximum reward that may be offered under appropriately designed wellness programs.”

Health Insurance Exchange and Revised COBRA Model Election Notices Released

The Affordable Care Act (ACA) added a section to the Fair Labor Standards Act (FLSA) that said an applicable employer must provide a written notice to each existing employee no later than March 1, 2013, and to new hires beginning on that date. But on January 24, 2013, the Department of Labor (DOL) put out an FAQ that recognized that was an unrealistic deadline.

On May 8, 2013, the DOL provided an update with temporary guidance and templates of the required Exchange Model Notices (For Employers who offer a health plan and Employers who do not offer a health plan) and the Revised Model COBRA Election Notice. Starting on October 1, 2013, the notices have to be given to new employees on the day they are hired. The notices have to be given to existing employees no later than October 1, 2013.

The notices, along with further guidance, can be found at www.dol.gov/ebsa. Please review the attached Health Care Reform Hot Topic for more information on the Model Notices Explanation.

Will Health Care Reform Make Workers Cheaper to Insure?

DOL Releases Guidance on Model Exchange Notice & Model COBRA Election Notice

The Department of Labor released Technical Release 2013-02 on May 8, 2013. It provided guidance for the Model Exchange Notice and the Model COBRA Election Notice. A copy of Technical Release 2013-02 follows:

I. Introduction

This Technical Release provides temporary guidance regarding the notice requirement under FLSA section 18B and announces the availability of the Model Notice to Employees of Coverage Options. This Technical Release also provides an updated model election notice for group health plans for purposes of the continuation coverage provisions under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to include additional information regarding health coverage alternatives offered through the Marketplace.

New forms in health care's reform - Simplified Applications

On April 30, 2013, the Centers for Medicare & Medicaid Services (CMS) announced that the application for health coverage has been simplified and significantly shortened. The application for individuals without health insurance has been reduced from twenty-one to three pages, and the application for families is reduce by two-thirds. The consumer friendly forms are much shorter than industry standards for health insurance applications today.

In addition, for the first time consumers will be able to fill out one simple application and see their entire range of health insurance options, including plans in the Health Insurance Marketplace, Medicaid, the Children's Health Insurance Program (CHIP) and tax credits that will help pay for premiums.

Departments Issue FAQ on Summary of Benefits & Coverage Changes

On Tuesday, April 23, 2013, HHS, Treasury and the DOL published Part XIV of their FAQs on the Affordable Care Act, focusing on revisions to the Summary of Benefits and Coverage (SBC).

 

The seven-question FAQs introduce two primary changes, which take effect for plan years starting on or after January 1, 2014:

• A statement indicating whether a plan provides minimum essential coverage (MEC)
• A statement answering whether the plan's share of the total allowed costs of benefits meets applicable minimum value (MV) requirements (i.e., at least 60 percent of allowed charges for covered services, also known as bronze level coverage)

Plans may provide this information by either updating their SBCs or providing it in a cover letter. The departments provided sample language in the FAQs. In addition, the SBC template has been updated as well as the sample completed SBC. The uniform glossary remains unchanged.

 

In a previous notice, the departments indicated that more wholesale changes would be likely for 2014, including revisions and additions to the coverage examples. However, these FAQs confirm that the MEC and MV statements are the only required changes. Also, much of the transition relief provided in 2013 has been extended to 2014. See Q/A-5 in the FAQs for additional details.

 

FAQs about the the Affordable Care Act Implementation Part XIV

 

Original article courtesy of Infinisource:  http://newsroom.infinisource.com/post/2013/04/25/Departments-Issue-FAQ-on-Summary-of-Benefits-Coverage-Changes.aspx

Affordable Care Act Rate Shock?

Come January 1 of next year, those with the lowest health insurance risk may be hit the hardest with premium increases as high as 40%.

If you are young, healthy and qualify for non-group coverage, you could face rate hikes forcing you to reconsider how you spend your health care dollars.

And because of new age rating band requirements tied to the ACA, the 18 to 44 age group’s premiums will increase while the over 57 group will decrease.

Full Article:  Affordable Care Act Rate Shock?

Affordable Care Act Coverage: 5 Key Numbers

Amidst the confusion, there are some key numbers in the law, and the ADP research that can help make sense of the 2014 health insurance requirements:

• 50. That's the number of full-time employees that determines whether an organization is a small employer under the law.
• 30/130. Employees with more than 30 hours of service per week or 130 hours of service per month must have access to employer-sponsored health care benefits
• 9.5. The law says employer-offered health insurance is not affordable if the cost to purchase coverage totals more than 9.5 percent of an employee's wage income per a W-2 statement.
• 45,000. This is the annual income level that ADP finds separates employees who generally buy health insurance from those who don't.
• 8.6. In its research, ADP found that 8.6 percent of the single employees in its client companies had to pay more than 9.5 percent for health insurance.

Full Article: Affordable Care Act Coverage: 5 Key Numbers

Five Myths About Obamacare You Probably Believe

Misconceptions and myths about the Affordable Care Act (ACA; aka Obamacare) abound. That’s not good, says Ron Pollack, the head of FamiliesUSA, an advocacy group based in Washington, D.C. That’s why Pollack’s group recently put together a list of myths, along with the correct information, about this important law and the changes it will soon bring:

• Myth #1: Starting in 2014, everyone must either have health insurance or pay a penalty—no exceptions.
• Myth # 2: If you’re insured through your employer, Obamacare won’t help you.
• Myth #3: All businesses will be required to provide health insurance to their employees.
• Myth #4: Undocumented immigrants will receive federal aid to buy health insurance.
• Myth #5: My state isn’t setting up its own health exchange, so it’s exempt from Obamacare.

Article:  Five Myths About Obamacare You Probably Believe

New fact sheets answer questions about Health Reimbursement Arrangements

An FAQ issued by the Department of Labor on January 24, 2013 stated that stand-alone HRAs used to buy an individual policy is not considered combined employer-sponsored coverage that follows the annual dollar limit requirement. If employees are offered an HRA and employer-sponsored coverage and turn down the employer-sponsored coverage, the stand-alone HRA will violate the law. The FAQ does allow amounts already in a stand-alone HRA before January 1, 2014 to be drawn on after that time if certain standards are met.

Anthem HRA Fact Sheet

Small Firms’ Offer of Plan Choices Under Health Law Delayed

Unable to meet tight deadlines in the new health care law, the Obama administration is delaying parts of a program intended to provide affordable health insurance to small businesses and their employees — a major selling point for the health care legislation. Because of what the Obama administration called “operational challenges,” most small companies that buy insurance through an exchange will offer workers just one option next year.

Article: Small Firms’ Offer of Plan Choices Under Health Law Delayed

Obamacare credits could trigger surprise tax bills

Overview: The new health care law will offer subsidies to help people buy private health insurance on state-based exchanges, if they don't already get coverage through their employers. The subsidies are based on income.

What happens if you or your spouse gets a raise and your family income goes up in 2014? You could end up with a bigger subsidy than you are entitled to. If that happens, the law says you have to pay back at least part of the money when you file your tax return in the spring of 2015.

That could result in smaller tax refunds or surprise tax bills for millions of middle-income families.

Article:  Obamacare credits could trigger surprise tax bills

Sebelius concedes reform could raise premiums

Overview: Years after the insurance industry began warning that premiums will rise due to health reform, the Obama administration acknowledged Tuesday that it might actually be the case.

Health and Human Services Secretary Kathleen Sebelius told reporters at the White House that some people may see their premiums rise under the Patient Protection and Affordable Care Act.

Article:  Sebelius concedes reform could raise premiums

Study: Health overhaul to raise claims cost 32 pct

Overview: A new study finds that insurance companies will have to pay out an average of 32 percent more for medical claims on individual health policies under President Barack Obama's health care overhaul.

What does that mean for you?  It could increase premiums for at least some Americans.

Article: Study: Health overhaul to raise claims cost 32 pct

Small Businesses Pursue Health Law ‘Loophole’

Summary: Self-insurance, once the purview of only large companies, is becoming popular with small employers, too. But it could be a threat to the Affordable Care Act, since self-insured companies are exempt from many of the health law's requirements.

Article:  Small Businesses Pursue Health Law ‘Loophole’

Affordable Care Act at 3: Looking Forward and Expanding Access

By Kathleen Sebelius, Secretary of Health and Human Services

Posted March 22, 2013

Thanks to the health care law, qualified individuals will have access to quality insurance through the Health Insurance Marketplace.

Full Article:  Affordable Care Act at 3: Looking Forward and Expanding Access

Small Employers Are Clueless About Obamacare

Article:  http://www.businessweek.com/articles/2013-03-21/small-employers-are-clueless-about-obamacare

Most PPACA Provisions for Expatriate Plans Delayed Until 2015

On March 8, 2013, the Departments of Labor, Health and Human Services and Treasury issued a Frequently Asked Question (FAQ) announcing that compliance with most Patient Protection and Affordable Care Act (PPACA) provisions is being delayed for expatriate plans meeting this definition:

HRAs & PCORI Fees

As part of The Patient Protection and Affordable Care Act (PPACA) a new fee was introduced to be paid by health insurers and self-funded plan sponsors to fund the Patient-Centered Outcomes Research Institute (PCORI). The PCORI was established by the Act to promote the use of evidence-based medicine by disseminating comparative clinical effectiveness research findings. In mid December, the IRS released final regulations and guidance on the calculation and payment of the PCORI fees. Plans that are subject to the fee are:

Health Care Reform News for 2013

With the Supreme Court Ruling and the Elections behind us, the majority of the obstacles to the implementation of the Affordable Care Act (ACA) have been cleared. The question is no longer if, but when and how ACA will be established in each state.

Please review the Health Care Reform News for some key provisions for Health Care Reform new in 2013 and provisions from prior years impacting 2013:

• Exchange/Marketplace Creation,
• Employer Exchange Notices—DELAYED,
• New Taxes, Limits, and Fees,
• Uniform Summary of Benefits and Coverage (SBC) Forms and Notice of Material Modifications,
• Women's Preventive Services,
• Medical Loss Ratio Rebate,
• W-2 Reporting, and
• Small Business Health Care Tax Credit—available through 2013.

Medicaid Expansion

The Supreme Court's ruling on the Affordable Care Act (ACA) allowed states to opt out of the law's Medicaid expansion, leaving each state's decision to participate in the hands of the nation's governors and state leaders.

Some governors of states who weren’t expected to support Medicaid expansion have announced the intention to do so. Still others are holding firm that expanding a system they view as flawed is a recipe for disaster.

Medical Loss Ratio Rebates - Final Rule Update

HHS is amending the Medical Loss Ratio program, also known as the 80 / 20 rule, to ensure that, beginning in 2014, issuers include premium stabilization amounts in medical loss ratio and rebate calculations. HHS is extending the annual medical loss ratio reporting deadline from June 1 to July 31, and the rebate disbursement deadline from August 1 to September 30 to take into account the premium stabilization programs. This change will allow issuers to accurately calculate their medical loss ratios while ensuring that consumers receive rebates as quickly as possible. HHS is also allowing tax-exempt not-for-profit issuers to deduct community benefit expenditures (subject to caps) and State premium tax from premium in calculating medical loss ratios and rebates. This change promotes a level playing field for issuers within each State.

Welcome to our Health Care Reform News Feed!

As part of our ongoing commitment to keep you informed, Sterling Benefits has added a resource to release the latest updates in a timely manner without inundating you with emails. We encourage you to read our News Feed at your leisure or you may subscribe to the “blog” to receive a digest of any communications.

We have populated the News Feed with past communications to better assist you.

We’ll continue to send out updates as they become available, but we encourage you to review the information and utilize our website and office as a resource in addressing questions and concerns. The website includes previous Sterling publications, hot topics, resource links, highlights, timelines and calendars.  Please feel free to share this website and invite people to sign up for electronic Reform updates!

As always, we appreciate the opportunity to be of service.

Thank you,
Christina & Brenda

HHS Conditionally Approves Four More Partnership Exchanges

On 3/7/2013, HHS'announced that it was offering conditional approval to four more partnership exchanges under the Affordable Care Act.

Michigan, New Hampshire, West Virginia and Iowa are the final four states to receive conditional federal approval to run state partnership health insurance exchanges.

The announcement means 24 states and the District of Columbia have submitted plans to operate or partially operate health exchanges.

Small Business Health Care Tax Credit Reduction

Effect of Sequestration on Small Business Health Care Tax Credit
Pursuant to the requirements of the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, certain automatic cuts took place as of March 1, 2013. These required cuts include a reduction to the refundable portion of the Small Business Health Care Tax Credit for certain small tax-exempt employers under Internal Revenue Code section 45R. As a result, the refundable portion of your claim will be reduced by 8.7 percent. The sequestration reduction rate will be applied until the end of the fiscal year (Sept. 30, 2013) or intervening Congressional action, at which time the sequestration rate is subject to change.

IRS Press Release 3/6/2012

Pre-Existing Condition Insurance Plan Enrollment Suspension

Beginning February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications until further notice. State-based PCIPs may continue accepting enrollment applications through March 2, and will then suspend acceptance of new enrollment applications until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide.

This suspension will help ensure that funds are available through 2013 to continuously cover people currently enrolled in PCIP.

Federal Government To Run Insurance Marketplaces In Half The States

Article:  Federal Government To Run Insurance Marketplaces In Half The States - Kaiser Health News

HHS Releases Final Regulations on Essential Health Benefits Standards

On February 20, 2013, the Department of Health and Human Services (HHS) released a final rule that helps consumers shop for and compare health insurance options in the individual and small group markets by promoting consistency across plans, protecting consumers by ensuring that plans cover a core package of items that are equal in scope to benefits offered by a typical employer plan, and limiting their out of pocket expenses.

The Final Rules include details on:

• Essential Health Benefits (EHB) benchmark and default plans
• Determining Actuarial Value (AV) and Employer Mandate Minimum Value (MV)
• Preventive care
• Cost sharing requirements

Proposed Rule Eases Contraceptive Mandate for Non-Profit Religious Organizations

On February 1, 2013, the Departments of Health and Human Services announced a proposed rule that, according to an agency press release, lays out "how nonprofit religious organizations, such as nonprofit religious hospitals or institutions of higher education, that object to contraception on religious grounds can receive an accommodation that provides their enrollees separate contraceptive coverage, and with no co-pays, but at no cost to the religious organization."

Here's the HHS fact sheet and proposed rule.

W-2 reporting communication for employees

As part of the Affordable Care Act (or health care reform law), W-2 forms must show the cost of employer-sponsored health coverage. Anthem has provided this suggested communication below that would come from the employer to notify employees of this new entry on their W-2s :

Draft Application for Health Insurance Coverage

On January 25, 2013, the Centers for Medicare and Medicaid Services (CMS) released draft versions of online and paper applications which consumers will fill out to buy policies in the new health insurance marketplaces, which are slated to begin enrolling people in October.

Drafts of the paper application and a 60-page description of the online version were quietly posted online by the Health and Human Services Department, seeking feedback from industry and consumer groups via the paperwork reduction act (PRA). The government's draft application runs 15 pages for a three-person family. An outline of the online version has 21 steps, some with additional questions.

At least three major federal agencies, including the IRS, will scrutinize your application. Checking your identity, income and citizenship is supposed to happen in real time, if you apply online.

The government estimates its online application will take a half hour to complete, on average. If you need a break, or have to gather supporting documents, you can save your work and come back later. The paper application is estimated to take an average of 45 minutes.

CMS Video of Proposed Application

Exchange Notification to Employees Delayed

The deadline for employers to notify employees of the availability of Exchanges has been delayed from March 1, 2013, to late summer or fall of 2013. The Department of Labor is considering providing model, generic language that could be used to satisfy the notice requirement. Future guidance on complying with the notice requirement under the Fair Labor Standards Act (FLSA) section 18B is expected to provide flexibility and adequate time to comply.Department of Labor (DOL) Press Release & FAQ's January 24, 2013

HHS To Waive, Extend Deadline for Health Insurance Exchanges

HHS Secretary Kathleen Sebelius has announced she will extend or waive the deadline again for states interested in running their own health insurance exchange or partnering with the federal government, the New York Times reports.

Under the Affordable Care Act, Sebelius was directed to determine "on or before Jan. 1, 2013," whether states were prepared to run their own exchanges. However, instead of determining now whether the exchanges are ready, HHS will work with states and set timelines and goals to progress toward creating an exchange.

Gary Cohen, director of the federal Center for Consumer Information and Insurance Oversight, said, "There is no deadline," adding, "We are going to give final approval once states demonstrate that they are able to satisfy all the requirements and meet all the conditions of operating an exchange."

Currently there are 18 Declared State-based Exchange, 7 Planning for Partnership Exchange, and
26 Default to Federal Exchange.

Visit the Henry J. Kaiser Family Foundation's state health facts web page for details on state participation in health insurance exchanges.

Health Insurance Exchanges 101 Guide

As part of the Affordable Care Act (ACA or health care reform law), starting in 2014 ALL Americans must have a minimum amount of health insurance or be taxed by the government. The law also requires each state to have a health insurance exchange where people can buy health insurance coverage. People who don’t get health insurance at work, or can’t afford it, may be able to get it through an exchange. The exchanges do not replace buying health insurance privately. They are simply a new place to shop and buy.

Article:  Health Insurance Exchanges 101 Guide

IRS Reminders for January 1, 2013

• Itemized Medical Deductions increased to 10%.
• FSA Medical account limit decreased to $2,500.
• Medicare Tax withholding increase.
• W-2 Reporting - Employers who filed 250 or more Form W-2s in calendar year 2011 must report applicable employer-sponsored coverage in Box 12 of the Forms W-2 issued by January 31, 2013.