Health Care Reform Updates & Human Resource News Alerts

Health Care Reform News

HR360::Health Care Reform
  • What is the 'Age 26' Requirement Under the ACA?

    Posted on August 18, 2017
    Print

    Law Requires Certain Employers to Offer Dependent Coverage Until Age 26

    Under the Affordable Care Act, when a plan covers dependents, it must continue to make the coverage available until a child reaches the age of 26, even if the young adult has been offered coverage through his or her own employer, is married, no longer lives with his or her parents, is not a dependent on a parent's tax return, or is no longer a student. 

    There is no federal requirement compelling a plan or issuer to offer dependent coverage. However, applicable large employers may be liable for a "pay or play" penalty if they do not offer coverage to the dependents of their full-time employees through the entire calendar month during which the dependent attains age 26.

    Note: Individual states may have dependent coverage requirements that are more favorable to employees. Employers and plan administrators should consult with their state insurance department to determine if additional requirements apply to their plans.

    © 2012 - 2013 HR 360, Inc.
  • IRS Releases Draft 2017 Forms 1094 and 1095

    Posted on August 07, 2017
    Print

    Final 2017 Versions to be Released Later

    The IRS has released draft versions of the Forms 1094-B, 1095-B, 1094-C, and 1095-C that employers and insurers will use in early 2018 to report on health coverage offered in the 2017 calendar year.

    2017 Draft Forms
    The following draft forms are now available for 2017:

    If finalized, the most significant change to the 2017 forms would be the removal of the "Section 4980H Transition Relief" box from line 22 of Form 1094-C. This transition relief is no longer available to employers.

    Background
    The Affordable Care Act (ACA) requires insurers, self-insuring employers, and other parties that provide minimum essential health coverage to report information on this coverage to the IRS and to covered individuals using Forms 1094-B and 1095-B. Applicable large employers (generally those with 50 or more full-time employees, including full-time equivalents) are also required to report information to the IRS and to their employees about their compliance with the employer shared responsibility provisions ("pay or play") and the health care coverage they have offered using Forms 1094-C and 1095-C.

    © 2012 - 2013 HR 360, Inc.
  • Reminder: Individual Marketplace Open Enrollment Begins Nov. 1

    Posted on August 01, 2017
    Print

    Marketplace Special Enrollment Period Rules Also Modified

    The 2018 open enrollment period to obtain coverage in the individual Health Insurance Marketplace runs from November 1, 2017 through December 15, 2017, with coverage starting January 1, 2018. After this period, individuals can enroll or change plans only if they qualify for a special enrollment period.

    Special Enrollment Period Rules
    Federal agencies previously announced modifications to the Marketplace special enrollment period rules, as follows:

    • Pre-enrollment verification of eligibility will generally be conducted for all categories of special enrollment periods;
    • The ability of existing Marketplace enrollees to change plan metal levels during the coverage year will be limited;
    • Issuers will be permitted to deny Marketplace special enrollment due to loss of minimum essential coverage where the issuer has a record of termination due to non-payment of premiums by the individual, unless obligations for premiums due for previous coverage are fulfilled.

    Click here for additional information regarding special enrollment periods. For more on applicable dates and deadlines, click here.

    © 2012 - 2013 HR 360, Inc.
  • Reminder: Issuer MLR Rebates Due to Plan Sponsors by Sept. 30

    Posted on July 17, 2017
    Print

    Overview of Employer Responsibilities for Handling Rebates

    The Medical Loss Ratio (MLR) rules under Health Care Reform require an issuer to provide rebates if its medical loss ratio (the amount of health insurance premiums spent on health care and activities to improve health care quality) falls short of the applicable standard during a reporting year. Each year's rebates must be provided by issuers to policyholders (typically the employer that sponsors the plan) by September 30 of the following year.

    Employer Distribution
    The MLR rules provide that issuers must pay any rebates owed to persons covered under a group health plan to the policyholder, who is then responsible for distributing the rebate to eligible plan enrollees. In general, there are several ways rebates may be distributed to plan enrollees, including:

    • A rebate check in the mail;
    • A lump-sum reimbursement to the same account that was used to pay the premium if it was paid by credit card or debit card; or
    • A direct reduction in future premiums.

    In addition to the above methods, employers may also apply the rebate in a way that benefits employees. Note that decisions on how to apply or expend the plan's portion of a rebate are subject to the general standards of fiduciary conduct under the federal Employee Retirement Income Security Act (ERISA). For additional details, click here.

    © 2012 - 2013 HR 360, Inc.
  • Alaska Granted Waiver From Individual Market Single Risk Pool

    Posted on July 13, 2017
    Print

    Waiver Allows Implementation of Alaska Reinsurance Program for 2018 and Future Years

    The U.S. Departments of Health and Human Services and Treasury have approved the State of Alaska's application for a waiver from the Affordable Care Act requirement that it consider all enrollees in the individual market to be part of a single risk pool. The waiver allows Alaska to implement the Alaska Reinsurance Program (ARP) for the next five plan years, from January 1, 2018 through December 31, 2022.

    ARP Implementation
    ARP is a state-operated reinsurance program which covers claims in the individual market for individuals with one or more of 33 identified high-cost conditions to help stabilize premiums. As a result of the waiver approval and implementation of the ARP for 2018 and future years, state and federal agencies anticipate that more consumers in Alaska will have coverage and will see lower premiums (which are projected to be 20% lower in 2018 than they would be without the waiver).

    State Innovation Waivers
    Section 1332 of the ACA permits a state to apply for a "State Innovation Waiver" to pursue innovative strategies for providing its residents with access to quality health care, as long as the waiver request meets certain requirements to retain the basic protections of the ACA. The waivers are approved for five-year periods and can be renewed.

    © 2012 - 2013 HR 360, Inc.
  • Reminder: Small Businesses Can Qualify for Health Care Tax Credit

    Posted on July 07, 2017
    Print

    Overview of Eligibility Requirements for Small Employers

    The Small Business Health Care Tax Credit is designed to encourage small businesses and small tax-exempt employers to offer health insurance coverage to their employees. The credit can be worth up to 50% of the amount a small business contributes toward employees' premiums (35% for tax-exempt small employers).

    In general, an employer may be eligible for the credit if it:

    • Had fewer than 25 full-time equivalent employees;
    • Paid an average wage of less than $52,000 a year;
    • Paid at least half of its employees' premium costs; and
    • Paid premiums on behalf of employees enrolled in a qualified health plan offered through the Small Business Health Options Program (SHOP) Marketplace (with limited exceptions).

    A Small Business Health Care Tax Credit Estimator is available from Healthcare.gov, and an IRS Small Business Health Care Tax Credit information page provides additional details on claiming the credit.

    © 2012 - 2013 HR 360, Inc.

    HR News and Alerts

    HR360::Health Care Reform
    • What is the 'Age 26' Requirement Under the ACA?

      Posted on August 18, 2017
      Print

      Law Requires Certain Employers to Offer Dependent Coverage Until Age 26

      Under the Affordable Care Act, when a plan covers dependents, it must continue to make the coverage available until a child reaches the age of 26, even if the young adult has been offered coverage through his or her own employer, is married, no longer lives with his or her parents, is not a dependent on a parent's tax return, or is no longer a student. 

      There is no federal requirement compelling a plan or issuer to offer dependent coverage. However, applicable large employers may be liable for a "pay or play" penalty if they do not offer coverage to the dependents of their full-time employees through the entire calendar month during which the dependent attains age 26.

      Note: Individual states may have dependent coverage requirements that are more favorable to employees. Employers and plan administrators should consult with their state insurance department to determine if additional requirements apply to their plans.

      © 2012 - 2013 HR 360, Inc.
    • IRS Releases Draft 2017 Forms 1094 and 1095

      Posted on August 07, 2017
      Print

      Final 2017 Versions to be Released Later

      The IRS has released draft versions of the Forms 1094-B, 1095-B, 1094-C, and 1095-C that employers and insurers will use in early 2018 to report on health coverage offered in the 2017 calendar year.

      2017 Draft Forms
      The following draft forms are now available for 2017:

      If finalized, the most significant change to the 2017 forms would be the removal of the "Section 4980H Transition Relief" box from line 22 of Form 1094-C. This transition relief is no longer available to employers.

      Background
      The Affordable Care Act (ACA) requires insurers, self-insuring employers, and other parties that provide minimum essential health coverage to report information on this coverage to the IRS and to covered individuals using Forms 1094-B and 1095-B. Applicable large employers (generally those with 50 or more full-time employees, including full-time equivalents) are also required to report information to the IRS and to their employees about their compliance with the employer shared responsibility provisions ("pay or play") and the health care coverage they have offered using Forms 1094-C and 1095-C.

      © 2012 - 2013 HR 360, Inc.
    • Reminder: Individual Marketplace Open Enrollment Begins Nov. 1

      Posted on August 01, 2017
      Print

      Marketplace Special Enrollment Period Rules Also Modified

      The 2018 open enrollment period to obtain coverage in the individual Health Insurance Marketplace runs from November 1, 2017 through December 15, 2017, with coverage starting January 1, 2018. After this period, individuals can enroll or change plans only if they qualify for a special enrollment period.

      Special Enrollment Period Rules
      Federal agencies previously announced modifications to the Marketplace special enrollment period rules, as follows:

      • Pre-enrollment verification of eligibility will generally be conducted for all categories of special enrollment periods;
      • The ability of existing Marketplace enrollees to change plan metal levels during the coverage year will be limited;
      • Issuers will be permitted to deny Marketplace special enrollment due to loss of minimum essential coverage where the issuer has a record of termination due to non-payment of premiums by the individual, unless obligations for premiums due for previous coverage are fulfilled.

      Click here for additional information regarding special enrollment periods. For more on applicable dates and deadlines, click here.

      © 2012 - 2013 HR 360, Inc.
    • Reminder: Issuer MLR Rebates Due to Plan Sponsors by Sept. 30

      Posted on July 17, 2017
      Print

      Overview of Employer Responsibilities for Handling Rebates

      The Medical Loss Ratio (MLR) rules under Health Care Reform require an issuer to provide rebates if its medical loss ratio (the amount of health insurance premiums spent on health care and activities to improve health care quality) falls short of the applicable standard during a reporting year. Each year's rebates must be provided by issuers to policyholders (typically the employer that sponsors the plan) by September 30 of the following year.

      Employer Distribution
      The MLR rules provide that issuers must pay any rebates owed to persons covered under a group health plan to the policyholder, who is then responsible for distributing the rebate to eligible plan enrollees. In general, there are several ways rebates may be distributed to plan enrollees, including:

      • A rebate check in the mail;
      • A lump-sum reimbursement to the same account that was used to pay the premium if it was paid by credit card or debit card; or
      • A direct reduction in future premiums.

      In addition to the above methods, employers may also apply the rebate in a way that benefits employees. Note that decisions on how to apply or expend the plan's portion of a rebate are subject to the general standards of fiduciary conduct under the federal Employee Retirement Income Security Act (ERISA). For additional details, click here.

      © 2012 - 2013 HR 360, Inc.
    • Alaska Granted Waiver From Individual Market Single Risk Pool

      Posted on July 13, 2017
      Print

      Waiver Allows Implementation of Alaska Reinsurance Program for 2018 and Future Years

      The U.S. Departments of Health and Human Services and Treasury have approved the State of Alaska's application for a waiver from the Affordable Care Act requirement that it consider all enrollees in the individual market to be part of a single risk pool. The waiver allows Alaska to implement the Alaska Reinsurance Program (ARP) for the next five plan years, from January 1, 2018 through December 31, 2022.

      ARP Implementation
      ARP is a state-operated reinsurance program which covers claims in the individual market for individuals with one or more of 33 identified high-cost conditions to help stabilize premiums. As a result of the waiver approval and implementation of the ARP for 2018 and future years, state and federal agencies anticipate that more consumers in Alaska will have coverage and will see lower premiums (which are projected to be 20% lower in 2018 than they would be without the waiver).

      State Innovation Waivers
      Section 1332 of the ACA permits a state to apply for a "State Innovation Waiver" to pursue innovative strategies for providing its residents with access to quality health care, as long as the waiver request meets certain requirements to retain the basic protections of the ACA. The waivers are approved for five-year periods and can be renewed.

      © 2012 - 2013 HR 360, Inc.
    • Reminder: Small Businesses Can Qualify for Health Care Tax Credit

      Posted on July 07, 2017
      Print

      Overview of Eligibility Requirements for Small Employers

      The Small Business Health Care Tax Credit is designed to encourage small businesses and small tax-exempt employers to offer health insurance coverage to their employees. The credit can be worth up to 50% of the amount a small business contributes toward employees' premiums (35% for tax-exempt small employers).

      In general, an employer may be eligible for the credit if it:

      • Had fewer than 25 full-time equivalent employees;
      • Paid an average wage of less than $52,000 a year;
      • Paid at least half of its employees' premium costs; and
      • Paid premiums on behalf of employees enrolled in a qualified health plan offered through the Small Business Health Options Program (SHOP) Marketplace (with limited exceptions).

      A Small Business Health Care Tax Credit Estimator is available from Healthcare.gov, and an IRS Small Business Health Care Tax Credit information page provides additional details on claiming the credit.

      © 2012 - 2013 HR 360, Inc.