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Employers will have two more years in which to respond to an Affordable Care Act tax on high-cost health plans, which was due to take effect in 2018. On Dec. 18, President Obama signed an omnibus spending package that includes a two-year delay of the Cadillac tax and also reversed the tax’s non-deductible status. The […]
Employers that purchase small group coverage that is federally regulated under the Affordable Care Act will have additional assurances that their plan members will not be balance billed in certain situations, under proposed rules issued in pre-publication form on Nov. 22. The rule also plans for the adoption of network adequacy provisions to compensate for […]
Thanks to cost pressures exacerbated by the Affordable Care Act, narrow-network plans have increased in popularity because of their lower premiums, but plans using such networks need to think about associated potential problems with poor provider access, balance billing and provider directory information. Detailed information about the latest regulatory and legislative measures to prevent balance […]
How much a health plan may change before losing grandfathered plan status was addressed in a final Affordable Care Act rule issued on Nov. 13 by the three U.S. departments that administer ACA reform. The rule (which takes effect on Jan. 1, 2017) finalizes familiar pieces of agency guidance, many of them issued in 2010. The rule also addresses […]
Large employers with 200 and more employees will not have to automatically enroll their workforces into health plans, under budget legislation signed by President Obama. This Affordable Care Act provision was repealed because it was a low government priority and because business objected to it. Rules explaining the provision were never issued and it never took […]
Plans may not impose cost-sharing on out-of-network services unless in-network providers are available and the plan member goes out of network in spite of that, federal agencies noted in FAQs on the ACA Part XXIX. But if network provider directories fail to list providers as offering the service in question, then plan members do not […]
On Oct. 7, 2015, President Obama signed, without comment, the Protecting Affordable Coverage for Employees Act, which amends the Affordable Care Act’s definition of a “small-group,” a move intended to force mid-sized companies into providing richer coverage to workers. The PACE Act (H.R. 1624 and S. 1099) repeals the mandatory expansion of the small group […]
Plan design can help employer plan sponsors avoid the objectionable task of paying excise taxes on health plan coverage they provide to employees. The Cadillac tax is the Affordable Care Act’s way of taxing health benefits, in part to fund the law’s ambitious coverage objectives. As liability under the tax in 2018 approaches, employers are […]
The U.S. House of Representatives in a voice vote on Sept. 28 unanimously approved H.R. 1624, the Protecting Affordable Coverage for Employees Act, which would redefine small employer as having 50 or fewer employees and give states the option of expanding the definition to include employers with up to 100 employees. The previous definition had been groups […]
Information reporting of minimum essential coverage under the Affordable Care Act is like being stuck between a rock and a hard place. On the one hand, insurers and many employer plan sponsors must keep records about their coverage and lives covered for every month of 2015. Details include Social Security numbers (for self-insured plans) and […]