On November 20, 2012, Affordable Care Act guidance was issued in the form of over 300 pages of proposed regulations. The guidance is broken into three parts: 1) requirements for essential health benefits, actuarial value, and other exchange related requirements; 2) various market reform initiatives; and 3) regulations related to employee wellness programs.
At this time, the proposed regulations related to the exchange requirements, as well as the market reform initiatives, will be more meaningful to industry practitioners. The proposed regulations related to wellness programs will be of greatest interest to employers.
In general, as of January 1, 2014, health plans will not be able to underwrite based on health status. Wellness programs have been granted a limited exemption. The maximum allowable reward under a wellness program as part of a group health plan has increased from twenty to Continue reading »
As a result of the Supreme Court upholding the Affordable Care Act (ACA), employers must continue to satisfy its requirements. In general, employer-sponsored group health plans that provide applicable employer-sponsored coverage are subject to ACA. There are a few limited exceptions, but most fully insured and self-insured group health plans are covered. If an employer determines their health benefits are covered, then they have several action items to address Continue reading »
As a result of the Affordable Care Act (ACA), some employers that sponsor group health plans have begun receiving Medical Loss Ratio (MLR) rebates from their health insurance carrier(s). Upon receipt of these rebate checks, employers have some decisions to make: Continue reading »
Lost in the storm after the Supreme Court’s recent decision on the Affordable Care Act (ACA) is the fact that the Act includes several important provisions that either remain in effect for 2012 or go into effect in 2013 and 2014. These provisions are outlined below:
- Ongoing disclosure and reporting requirements, including w-2 reporting of the value of individual insurance coverage for 2012
- Medical Loss Ratio (MLR) rebates – some employers who sponsor insured group health plans will begin receiving rebate checks from their carriers in the coming weeks
- Beginning in 2013, an additional 0.9% Medicare payroll tax on high income earners. High income earners are defined as individuals, filing separately, with earned income over $200,000 and joint filers with earned income over $250,000. The additional tax only applies Continue reading »
On June 28, 2012, the Supreme Court narrowly voted to uphold the majority of the Affordable Care Act (“the Act”). In the end, the basis for the decision was the federal government’s authority to tax. Under the Act, certain individuals that do not elect health insurance coverage must pay a financial penalty. This is commonly referred to as the Individual Mandate component of the Act. Five of the justices agreed that, while President Obama has taken great care to stay clear of the word “tax” in his healthcare reform efforts, such a financial penalty may reasonably be characterized as a tax. While the “tax” versus “penalty” debate makes for good TV, it remains to be seen how relevant it is to the overall healthcare reform debate. Surely from now until the Presidential election in November, the Democrats’ position Continue reading »