Tag: health reimbursement arrangements

After-tax HSAs may help employers avoid paying the Cadillac tax

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 […]

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Rules for QHP Transparency Soon Will Apply to Employers

Insurers and plan sponsors soon will have to report to the government (and list on a web page) their policies on: out-of-network liability and balance billing; enrollee claim submission; claims and denials; recoupment of overpayments; medical necessity; prior authorization; drug exception timeframes; explanations of benefits; and coordination of benefits. Guidance HHS published on Aug. 12 […]

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IRS Offers Temporary Safe Harbor for Some Premium Reimbursement Arrangements

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 […]

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Implant Charges Seen as Ripe for Health Plan Cost Control

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. […]

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High-deductible and Health-FSA Participation Grows

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 […]

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Skinny Plans: Adhering to the Letter (But Not the Sprit) of Health Reform

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, […]

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New Reform Rules Give More Guidance on Minimum Value Coverage

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 […]

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Rule on Reform’s Reinsurance Fee Clarifies Payments for Health Plans

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 […]

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Reform’s Essential Health Benefit Rule Clarifies Employer Plan Obligations

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 […]

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HRAs With Individual Policies Will Violate Reform Ban on Limits, HHS States

Health reimbursement arrangements that are not integrated with group health coverage will violate health reform’s prohibition on annual benefit limits, the federal government recently clarified. HRAs that are integrated with individual policies will be seen as “nonintegrated,” thereby violating the ban on annual limits, the agencies implementing health reform stated. And if employees don’t sign […]

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