Health Care Reform Updates & Human Resource News Alerts

Health Care Reform News

HR360::Health Care Reform
  • CMS to Propose Major Changes to Federal SHOP Marketplaces

    Posted on May 17, 2017
    Print

    If Finalized, Changes Would Expand Role of Insurance Brokers

    The Centers for Medicare and Medicaid Services (CMS) has announced its intention to propose major changes to how small employers in Small Business Health Options Program (SHOP) Marketplaces using HealthCare.gov would enroll in SHOP plans taking effect on or after January 1, 2018. Among other things, CMS intends to promote broker participation in SHOP plan enrollment.

    Background
    Established as part of the Affordable Care Act (ACA), SHOP Marketplaces offer eligible small employers an online process for offering health insurance coverage to their employees. The federal government operates federally facilitated SHOP Marketplaces in states that did not elect to establish their own state-based Marketplace, while some state-based SHOP Marketplaces also use the federal HealthCare.gov platform. Currently, employers wishing to purchase health insurance coverage through a federally facilitated SHOP Marketplace or a state-based SHOP Marketplace on the federal platform must verify eligibility for coverage, enroll in coverage, and make premium payments via HealthCare.gov.

    Intended Changes to SHOP Marketplaces
    Under the approach CMS intends to propose, SHOP enrollment in states that currently use the federal platform would be removed from HealthCare.gov. Instead, small employers would enroll in SHOP coverage with the assistance of a broker registered with a federally facilitated SHOP, or directly with an insurance company offering SHOP plans, for plan years beginning on or after January 1, 2018.  Employers would still obtain a determination of eligibility by going to HealthCare.gov.

    In addition, CMS anticipates that its intended proposal will give state-based SHOP Marketplaces the option to direct small employers to SHOP-registered brokers and insurance companies for SHOP plan enrollment.

    Click here for more information from CMS. 

    © 2012 - 2013 HR 360, Inc.
  • PCORI Fees Due July 31

    Posted on May 11, 2017
    Print

    Affected Employers Must File IRS Form 720

    Effective for plan years ending on or after October 1, 2012, and before October 1, 2019, employers that sponsor certain self-insured health plans are responsible for Patient-Centered Outcomes Research Institute (PCORI) fees. Fees for plan years that ended in 2016 are due July 31, 2017.

    How to Pay PCORI Fees
    Employers that sponsor certain self-insured health plans must report and pay the required PCORI fees via IRS Form 720, Quarterly Federal Excise Tax Return. For plan years ending between January 1, 2016 and September 30, 2016, the fee for an employer sponsoring an applicable self-insured plan is $2.17 multiplied by the average number of lives covered under the plan. For plan years ending between October 1, 2016 and December 31, 2016, the fee is $2.26 multiplied by the average number of lives covered under the plan.

    © 2012 - 2013 HR 360, Inc.
  • Reminder: Use of New SBC Template and Related Documents Now Required

    Posted on May 10, 2017
    Print

    Templates and Regulatory Guidance Available

    As a reminder, the U.S. Department of Labor previously released new versions of the Summary of Benefits and Coverage (SBC) template, instructions, uniform glossary, and related documents that are required for use on or after April 1, 2017. Under the Affordable Care Act, group health plans and health insurance issuers are generally required to provide a written SBC to plan participants and beneficiaries at specified times during the enrollment process and upon request.

    Changes to SBC Template
    The new SBC template includes an additional coverage example as well as language and terms to improve individuals' understanding of their health coverage. Specifically, the new template includes more information about cost sharing, such as enhanced language to explain deductibles, and requires plans to address individual and overall out-of-pocket limits. Changes have also been made to the SBC to improve readability.

    Implementation Date for Using New Template and Related Documents
    Health plans and issuers that maintain an annual open enrollment period are required to use the new versions beginning on the first day of the first open enrollment period that begins on or after April 1, 2017 with respect to coverage for plan years beginning on or after that date. Health plans and issuers that do not use an annual open enrollment period are required to use the new versions beginning on the first day of the first plan year that begins on or after April 1, 2017

    Click here to access the new SBC templates and related materials.

    © 2012 - 2013 HR 360, Inc.
  • IRS Releases 2018 ACA Required Contribution Percentages

    Posted on May 05, 2017
    Print

    Guidance Affects ACA's Premium Tax Credit & Individual Mandate Provisions

    Consistent with prior guidance, the Internal Revenue Service (IRS) has announced adjustments to the required contribution percentages that will be used in 2018 to determine whether an individual is eligible for a premium tax credit and an affordability exemption from the individual shared responsibility provisions (the "individual mandate").

    Premium Tax Credit Eligibility
    An individual may be eligible for a premium tax credit to purchase health coverage through the Health Insurance Marketplace (Exchange) if, among other things, he or she is not able to get affordable coverage through an eligible employer plan that provides minimum value. For this purpose, an employer-sponsored plan will be considered affordable for plan years beginning in 2018 if the portion of the annual premium an employee must pay for self-only coverage does not exceed 9.56% of his or her household income. 

    Individual Mandate Affordability Exemption
    The individual mandate requires every individual to have minimum essential health coverage for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return. One such exemption applies when the individual cannot afford coverage because the minimum amount he or she must pay for the premiums is more than a designated percentage of the individual's household income. For plan years beginning in 2018, the designated percentage will be 8.05%.

    Click here to read the IRS announcement. 

    © 2012 - 2013 HR 360, Inc.
  • New Expiration Date for Health Insurance Exchange Notices is May 31, 2017

    Posted on May 01, 2017
    Print

    Model Notices Previously Expired on April 30, 2017

    The U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) has extended the effective date of its model Health Insurance Exchange Notices through May 31, 2017. Previously, these model notices expired on April 30, 2017. No other changes have been made to these notices.

    Click here to access the model notices with the new expiration date. Please note that there are two separate notices--one for employers that offer a health plan to some or all employees, and another for employers that do not offer a health plan.

    These model notices are the most current versions provided by the EBSA. For further guidance regarding these notices, please contact the EBSA directly at 1-866-444-3272.

    © 2012 - 2013 HR 360, Inc.
  • IRS 'Pay or Play' Letters for 2015 Penalties Expected to Be Issued in 2017

    Posted on April 28, 2017
    Print

    Penalty Letters Separate & Distinct From Marketplace Notices

    The Internal Revenue Service (IRS) has announced that it expects the letters informing applicable large employers (ALEs) that filed Forms 1094-C and 1095-C of their potential liability for a "pay or play" payment for the 2015 calendar year (with reporting in 2016) to be issued in 2017. Going forward, the agency intends to issue letters informing ALEs that filed Forms 1094-C and 1095-C of their potential liability, if any, in the latter part of each calendar year in which reporting was due (for example, in late 2018 for reporting in 2018 for coverage in 2017).

    While the Health Insurance Marketplaces have begun sending letters to notify certain employers that one or more of their employees has been determined eligible for advance premium tax credits and cost-sharing reductions and has enrolled in a Marketplace plan, these letters do not indicate whether an employer is required to make a pay or play payment, as only the IRS can make such determinations.

    For the latest guidance on pay or play payments, please see IRS Q&As #55-58.

    © 2012 - 2013 HR 360, Inc.

    HR News and Alerts

    HR360::Health Care Reform
    • CMS to Propose Major Changes to Federal SHOP Marketplaces

      Posted on May 17, 2017
      Print

      If Finalized, Changes Would Expand Role of Insurance Brokers

      The Centers for Medicare and Medicaid Services (CMS) has announced its intention to propose major changes to how small employers in Small Business Health Options Program (SHOP) Marketplaces using HealthCare.gov would enroll in SHOP plans taking effect on or after January 1, 2018. Among other things, CMS intends to promote broker participation in SHOP plan enrollment.

      Background
      Established as part of the Affordable Care Act (ACA), SHOP Marketplaces offer eligible small employers an online process for offering health insurance coverage to their employees. The federal government operates federally facilitated SHOP Marketplaces in states that did not elect to establish their own state-based Marketplace, while some state-based SHOP Marketplaces also use the federal HealthCare.gov platform. Currently, employers wishing to purchase health insurance coverage through a federally facilitated SHOP Marketplace or a state-based SHOP Marketplace on the federal platform must verify eligibility for coverage, enroll in coverage, and make premium payments via HealthCare.gov.

      Intended Changes to SHOP Marketplaces
      Under the approach CMS intends to propose, SHOP enrollment in states that currently use the federal platform would be removed from HealthCare.gov. Instead, small employers would enroll in SHOP coverage with the assistance of a broker registered with a federally facilitated SHOP, or directly with an insurance company offering SHOP plans, for plan years beginning on or after January 1, 2018.  Employers would still obtain a determination of eligibility by going to HealthCare.gov.

      In addition, CMS anticipates that its intended proposal will give state-based SHOP Marketplaces the option to direct small employers to SHOP-registered brokers and insurance companies for SHOP plan enrollment.

      Click here for more information from CMS. 

      © 2012 - 2013 HR 360, Inc.
    • PCORI Fees Due July 31

      Posted on May 11, 2017
      Print

      Affected Employers Must File IRS Form 720

      Effective for plan years ending on or after October 1, 2012, and before October 1, 2019, employers that sponsor certain self-insured health plans are responsible for Patient-Centered Outcomes Research Institute (PCORI) fees. Fees for plan years that ended in 2016 are due July 31, 2017.

      How to Pay PCORI Fees
      Employers that sponsor certain self-insured health plans must report and pay the required PCORI fees via IRS Form 720, Quarterly Federal Excise Tax Return. For plan years ending between January 1, 2016 and September 30, 2016, the fee for an employer sponsoring an applicable self-insured plan is $2.17 multiplied by the average number of lives covered under the plan. For plan years ending between October 1, 2016 and December 31, 2016, the fee is $2.26 multiplied by the average number of lives covered under the plan.

      © 2012 - 2013 HR 360, Inc.
    • Reminder: Use of New SBC Template and Related Documents Now Required

      Posted on May 10, 2017
      Print

      Templates and Regulatory Guidance Available

      As a reminder, the U.S. Department of Labor previously released new versions of the Summary of Benefits and Coverage (SBC) template, instructions, uniform glossary, and related documents that are required for use on or after April 1, 2017. Under the Affordable Care Act, group health plans and health insurance issuers are generally required to provide a written SBC to plan participants and beneficiaries at specified times during the enrollment process and upon request.

      Changes to SBC Template
      The new SBC template includes an additional coverage example as well as language and terms to improve individuals' understanding of their health coverage. Specifically, the new template includes more information about cost sharing, such as enhanced language to explain deductibles, and requires plans to address individual and overall out-of-pocket limits. Changes have also been made to the SBC to improve readability.

      Implementation Date for Using New Template and Related Documents
      Health plans and issuers that maintain an annual open enrollment period are required to use the new versions beginning on the first day of the first open enrollment period that begins on or after April 1, 2017 with respect to coverage for plan years beginning on or after that date. Health plans and issuers that do not use an annual open enrollment period are required to use the new versions beginning on the first day of the first plan year that begins on or after April 1, 2017

      Click here to access the new SBC templates and related materials.

      © 2012 - 2013 HR 360, Inc.
    • IRS Releases 2018 ACA Required Contribution Percentages

      Posted on May 05, 2017
      Print

      Guidance Affects ACA's Premium Tax Credit & Individual Mandate Provisions

      Consistent with prior guidance, the Internal Revenue Service (IRS) has announced adjustments to the required contribution percentages that will be used in 2018 to determine whether an individual is eligible for a premium tax credit and an affordability exemption from the individual shared responsibility provisions (the "individual mandate").

      Premium Tax Credit Eligibility
      An individual may be eligible for a premium tax credit to purchase health coverage through the Health Insurance Marketplace (Exchange) if, among other things, he or she is not able to get affordable coverage through an eligible employer plan that provides minimum value. For this purpose, an employer-sponsored plan will be considered affordable for plan years beginning in 2018 if the portion of the annual premium an employee must pay for self-only coverage does not exceed 9.56% of his or her household income. 

      Individual Mandate Affordability Exemption
      The individual mandate requires every individual to have minimum essential health coverage for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return. One such exemption applies when the individual cannot afford coverage because the minimum amount he or she must pay for the premiums is more than a designated percentage of the individual's household income. For plan years beginning in 2018, the designated percentage will be 8.05%.

      Click here to read the IRS announcement. 

      © 2012 - 2013 HR 360, Inc.
    • New Expiration Date for Health Insurance Exchange Notices is May 31, 2017

      Posted on May 01, 2017
      Print

      Model Notices Previously Expired on April 30, 2017

      The U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) has extended the effective date of its model Health Insurance Exchange Notices through May 31, 2017. Previously, these model notices expired on April 30, 2017. No other changes have been made to these notices.

      Click here to access the model notices with the new expiration date. Please note that there are two separate notices--one for employers that offer a health plan to some or all employees, and another for employers that do not offer a health plan.

      These model notices are the most current versions provided by the EBSA. For further guidance regarding these notices, please contact the EBSA directly at 1-866-444-3272.

      © 2012 - 2013 HR 360, Inc.
    • IRS 'Pay or Play' Letters for 2015 Penalties Expected to Be Issued in 2017

      Posted on April 28, 2017
      Print

      Penalty Letters Separate & Distinct From Marketplace Notices

      The Internal Revenue Service (IRS) has announced that it expects the letters informing applicable large employers (ALEs) that filed Forms 1094-C and 1095-C of their potential liability for a "pay or play" payment for the 2015 calendar year (with reporting in 2016) to be issued in 2017. Going forward, the agency intends to issue letters informing ALEs that filed Forms 1094-C and 1095-C of their potential liability, if any, in the latter part of each calendar year in which reporting was due (for example, in late 2018 for reporting in 2018 for coverage in 2017).

      While the Health Insurance Marketplaces have begun sending letters to notify certain employers that one or more of their employees has been determined eligible for advance premium tax credits and cost-sharing reductions and has enrolled in a Marketplace plan, these letters do not indicate whether an employer is required to make a pay or play payment, as only the IRS can make such determinations.

      For the latest guidance on pay or play payments, please see IRS Q&As #55-58.

      © 2012 - 2013 HR 360, Inc.