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Non-grandfathered employer-sponsored group health plans must abide by out-of-pocket maximums for every individual covered, whether they are enrolled in “self-only” or in “other than self-only” (family) coverage. And the government stayed enforcement of the Affordable Care Act’s provider nondiscrimination rules, according to a new set of frequently asked questions from the departments that administer health care reform. […]
Small employers and certain other plan sponsors can continue to reimburse individual premiums until July 1, without the threat of extreme penalties for offering coverage that does not comply with Affordable Care Act insurance mandates, under new guidance from the Internal Revenue Service. IRS Notice 2015-17 reiterates IRS’ previous warning, in Notice 2013-54, that giving employees […]
Implants — spinal fusion; as well as hip, knee and shoulder replacements — have emerged as major price problems today. Costs are up and so is utilization, which explains the cost surge health plans are undergoing for these procedures, according to three attorneys from The Phia Group in Braintree, Mass., who spoke in a Jan. […]
Employers cannot simply give employees extra money to buy individual health insurance — whether through health reimbursement arrangements, health flexible spending arrangements or just plain cash — and expect to avoid “shared responsibility” penalties, the IRS with the U.S. Departments of Labor and Health and Human Services said in new frequently asked questions about the […]
On Dec. 16, the IRS issued clarifications on how the U.S. v. Windsor ruling on same-gender marriage affects the administration of cafeteria plans, flexible spending accounts and health savings accounts. IRS Notice 2014-1 is in the form of 10 questions and answers regarding midyear election changes, FSA reimbursements and contribution limits for HSAs and dependent […]
Participation in high-deductible health plans and health flexible spending accounts grew at a strong pace, according to the National Center for Health Statistics. The findings in “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–March 2013” suggest that employees’ interests in consumer-directed health plans is growing, information employers may find useful in […]
An increasing number of employers are examining providing a low-benefits health plan that covers only preventive health services but not high-price major medical claims. Offering this type of low cost or “skinny” plan is allowed under the health reform law. The question is: Will skinny plans trigger a large-employer exodus to de minimis coverage, and if so, […]
Determining whether group health coverage provides “minimum value” is key to avoiding penalties under health reform’s premium tax credit program, so employers will likely welcome new proposed rules that further explain MV criteria. The proposal, to be published May 3 by IRS, would complement language in final rules issued in February on how reform’s MV […]
Employer-sponsored plans that are secondary to Medicare are not subject to health reform’s expensive transitional reinsurance fee, nor are health flexible spending arrangements, health savings accounts and most health reimbursement arrangements. On March 11, 2013, the U.S. Department of Health and Human Services published its final regulation on the transitional reinsurance fee, which takes effect […]
Health reform’s final essential health benefits rule makes it clear that self-insured and large group health plans do not need to comply with limits on growth in employee cost-sharing, offer all 10 categories of essential health benefits, or meet actuarial minimums like small-group and individual policies. However, the regime explained in the rule is still […]