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.

IRS Releases Proposed Regulations on the Employer Mandate

On December 28, 2012, the IRS issued 144 pages of proposed regulations addressing the employer “shared responsibility” mandate (aka Play or Pay mandate) in the Affordable Care Act. In addition, the IRS issued a FAQ summarizing major points of the regulations. Some of the highlights include:

HHS Issues Guidance re: Market Rules, Essential Health Benefits

On November 20, 2012, several Federal agencies released Proposed Rules on Patient Protection and Affordable Care Act (PPACA) provisions that will impact insurers and group health plans. The rules are subject to the notice and comment process, and the final rules may vary significantly.

Health Care Reform Update – Summary of Benefits and Coverage

Effective for plan/policy years and open enrollments (OEs) beginning on or after September 23, 2012, health insurers and self-insured group health plans will be required to provide a standard Summary of Benefits & Coverage (SBC) to enrolled members.

The group administrator is responsible for distributing SBCs to plan participants at least 30 days prior to renewal date (during the first day of OE), at initial enrollment, during special enrollments, 60 days prior to a material modification, and upon request.

Under the SBC requirements, willful failure to comply could result in up to a $1,000 fine per plan participant or beneficiary for each failure. HHS or the DOL can also issue an additional fine of $100 per day per affected person until the SBCs are properly issued.


For a more comprehensive overview on SBCs, please review the Reform Update 10/1/2012 - SBC Explanation and the SBC Sample. Current clients can log in to MyBasicGuru to access the Employer Notifications Checklist & Guide as well as Carrier specific information and instructions on obtaining SBCs.

Expanded Women’s Preventive Care Services

Under the Affordable Care Act, women’s preventive health care – such as mammograms, screenings for cervical cancer, prenatal care, and other services – is covered with no cost sharing for new health plans.

Additional women’s preventive services that will be covered in plan years starting on or after August 1, 2012 without cost sharing requirements include: Well-woman visits; Gestational diabetes screening; HPV DNA testing; STI counseling, and HIV screening and counseling; Contraception and contraceptive counseling; Breastfeeding support, supplies, and counseling; and Domestic violence screening.

The full list of covered preventive services can be found online at www.healthcare.gov.