Health Reform & Compliance News
December 16, 2016 - Special Enrollment for Group Health Plans. Under HIPAA, group health plans generally must allow current employees and dependents to enroll in the group health plan if the employee or dependents lose eligibility for coverage in which they were previously enrolled. This FAQ clarifies that an individual is entitled to a special enrollment period if they lose individual market coverage. This could happen, for example, if an insurer covering the employee or dependent stops offering that individual market coverage. However, a loss of coverage due to a failure to timely pay premiums or for cause will not give the employee or dependent in a special enrollment right.
June 14, 2016 - PCORI Fee News: The Affordable Care Act (ACA), requires that all medical plans pay the Patient-Centered Outcomes Research fee to the IRS annually, based on the number of plan participants. Read more about PCORI fee requirements and calculating fees here:
May 1, 2016 - FMLA Guide Issued: Since it's enactment in 1993, the Family and Medical Leave Act (FMLA) has been the Department of Labor’s vehicle to promote work-life balance by supporting the principle that no workers should have to choose between their job and their family. The DOL has released their new guide entitled, appropriately enough, "Employer's Guide to the Family and Medical Leave Act." The guide is designed to provide direction when navigating through some of the complicated sections of the FMLA process. The also included scenarios that have caused confusion or been gray areas in the past. It is a wealth of knowledge right from the source. Download your copy of the Employer's Guide to the Family and Medical Leave Act here, or follow this link to the DOL web page: http://www.absencesoft.com/dol-fmla-employer-guide/#/
November 6, 2015 - New ALE Forms Released: This week, the IRS released final Forms 1095-B/C (2105) and a new ACA Information Center for Applicable Large Employers on IRS.gov/aca. The page features information and resources for employers of all sizes on how the healthcare law may affect them if they fit the definition of an applicable large employer (ALE). The information center includes: What’s trending for ALEs, how to determine if you are an ALE, resources for ALEs, and outreach materials. It also includes links to detailed information about tax provisions, including information reporting requirements for employers, questions and answers, and forms, instructions, publications, healthcare tax tips, flyers and videos.
October 5, 2015 - Defining Small Groups: Late last week Congress approved legislation that would make the biggest change to date to a key provision in the Affordable Care Act (ACA) regarding the definition of the small group health insurance market. On September 28th, the U.S. House of Representatives unanimously passed H.R. 1624, the Protecting Affordable Coverage for Employees (PACE) Act, which would allow states to choose whether to expand the small group market to include businesses with up to 100 employees, effectively halting the mandatory expansion of what constitutes a "small group" for insurance purposes. On October 1st, the Senate passed the House approved legislation with a strong bipartisan majority. The legislation now moves to the White House where the President has signaled his intention to sign the bill into law.
The original ACA mandate was largely expected to increase premiums for employers with between 51 and 100 employees. In an effort to minimize this disruption prior to the start of "open enrollment" - and to allow insurance carriers to modify the rates that they filed earlier in the year assuming a small group market of up to 100 - Congress moved quickly to pass the PACE Act, thus allowing states to voluntarily maintain their "small group" definition to only include businesses with 50 or fewer employees.
The legislation was spearheaded by a number of small business trade groups. While it is likely that states working with the ACA's Federally-facilitated Exchange will maintain their current definition of "small group" to firms with 50 or fewer employees, SIIA is concerned that states running their own ACA Exchange - such as New York - will define their small group market as 1 to 100 employees (which was originally called for under the ACA).
The definition of the small group market can be very important at the state level. Some state legislatures have passed laws requiring minimum attachment points for a "small group," which is tied to the state's definition of its small group market. Thus, a state decision on group size may affect the way stop loss is regulated.
For example, in New York State, the legislature already passed a law expanding its small group market up to 100 employees in anticipation of the ACA's mandate going into effect. This enacted law also expanded New York State's ban on the use of stop loss in the small group market. If the New York State legislature were to change the state's small group market definition back to groups of 50 and below, it would return the stop loss ban to where it had been since 1991.