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