United Benefit Advisors Insight and Analysis Blog

Danielle Capilla

Chief Compliance Officer at United Benefit Advisors

Recent Posts

House Passes AHCA Bill in First Step to Repeal and Replace the ACA

Posted by: Danielle Capilla    May 5, 2017 10:27:15 PM

On May 4, 2017, the U.S. House of Representatives passed House Resolution 1628, a reconciliation bill aimed at "repealing and replacing" the Patient Protection and Affordable Care Act (ACA). The bill, titled the "American Health Care Act of 2017" or "AHCA," will now be sent to the Senate for debate, where amendments can be made, prior to the Senate voting on the bill.

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Topics: ACA, Affordable Care Act, American Health Care Act

Man-in-the-Middle Attacks on ePHI, HIPAA Enforcement in the News

Posted by: Danielle Capilla    May 4, 2017 12:57:07 PM

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) issued its Man-in-the Middle Attacks and "HTTPS Inspection Products" guidance. The OCR warns organizations that have implemented end-to-end connection security on their internet connections using Secure Hypertext Transport Protocol (HTTPS) about using HTTPS interception products to detect malware over an HTTPS connection because the HTTPS interception products may leave the organization vulnerable to man-in-the-middle (MITM) attacks. In an MITM attack, a third party intercepts internet communications between two parties; in some instances, the third party may modify the information or alter the communication by injecting malicious code.

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Topics: HIPAA, protected health information, internet security, ePHI

ACA Market Stabilization Final Rule

Posted by: Danielle Capilla    Apr 27, 2017 9:30:00 AM

On April 18, 2017, the Department of Health and Human Services’ (HHS) Centers for Medicare & Medicaid Services (CMS) published its final rule regarding Patient Protection and Affordable Care Act (ACA) market stabilization.

The rule amends standards relating to special enrollment periods, guaranteed availability, and the timing of the annual open enrollment period in the individual market for the 2018 plan year, standards related to network adequacy and essential community providers for qualified health plans, and the rules around actuarial value requirements.

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Topics: Affordable Care Act, benefits enrollment, guaranteed availability policy, continuous coverage, open enrollment periods

SBC Template and Required Addendums for Covered Entities under ACA Section 1557

Posted by: Danielle Capilla    Apr 20, 2017 11:54:46 AM

A Summary of Benefits and Coverage (SBC) is four page (double-sided) communication required by the federal government. It must contain specific information, in a specific order, and with a minimum size type, about a group health benefit's coverage and limitations. If an employer providing an SBC is a covered entity under the Section 1557 of the Patient Protection and Affordable Care Act (ACA), additional requirements apply.

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Topics: summary of benefits and coverage, SBC, Affordable Care Act, ACA Section 1557

CMS Allows States to Extend Life of "Grandmothered" or Transitional Health Insurance Policies

Posted by: Danielle Capilla    Mar 21, 2017 9:30:00 AM

On February 23, 2017, the Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS) released its Insurance Standards Bulletin Series, in which it re-extended its transitional policy for non-grandfathered coverage in the small group and individual health insurance markets.

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Topics: ACA, health plan benchmarking, UBA Health Plan Survey, Danielle Capilla, Affordable Care Act, grandmothering, transitional relief, transitional health insurance policy

Tax Treatment of Fixed Indemnity Health Plans

Posted by: Danielle Capilla    Mar 9, 2017 9:30:00 AM

A fixed indemnity health plan pays a specific amount of cash for certain health-related events (for example, $40 per office visit or $100 per hospital day). The amount paid is neither related to the medical expense incurred, nor coordinated with other health coverage. Further, a fixed indemnity health plan is considered an "excepted benefit."

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Topics: ACA, HIPAA, excepted benefits, Danielle Capilla, Affordable Care Act, fixed indemnity health plan, fixed dollar indemnity plans, taxation of health benefits

Medicare Part D: Creditable Coverage Disclosures

Posted by: Danielle Capilla    Mar 7, 2017 9:30:00 AM

Entities such as employers with group health plans that provide prescription drug coverage to individuals that are eligible for Medicare Part D have two major disclosure requirements that they must meet at least annually:

  • Provide annual written notice to all Medicare eligible individuals (employees, spouses, dependents, retirees, COBRA participants, etc.) who are covered under the prescription drug plan.
  • Disclose to the Centers for Medicare and Medicaid Services (CMS) whether the coverage is "creditable prescription drug coverage."
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Topics: Medicare Part D, Danielle Capilla, health care cost, annual disclosures, prescription drug coverage, creditable coverage notice

The “Line 22” Question: Which Box(es) Do I Check?

Posted by: Danielle Capilla    Mar 1, 2017 9:30:00 AM

Under the Patient Protection and Affordable Care Act (ACA), individuals are required to have health insurance while applicable large employers (ALEs) are required to offer health benefits to their full-time employees.

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Topics: ACA, employer shared responsibility, Danielle Capilla, Affordable Care Act, play or pay requirements, applicable large employers, IRS Form 1094-C

IRS Q&A About Employer Information Reporting on Form 1094-C and Form 1095-C

Posted by: Danielle Capilla    Feb 22, 2017 9:30:00 AM

The Internal Revenue Service (IRS) recently updated its longstanding Questions and Answers about Information Reporting by Employers on Form 1094-C and Form 1095-C that provides information on:

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Topics: ACA, Danielle Capilla, Affordable Care Act, COBRA continuation coverage, Form 1094-C, IRS reporting, Form 1095-C, offer of coverage

FAQ on HIPAA Special Enrollment; QSE HRAs Released

Posted by: Danielle Capilla    Feb 8, 2017 9:53:35 AM

Recently, the Department of Labor (DOL), Department of Health and Human Services (HHS), and the Treasury (collectively, the Departments) issued FAQs About Affordable Care Act Implementation Part 35. The FAQ covers a new HIPAA special enrollment period, an update on women's preventive services that must be covered, and clarifying information on qualifying small employer health reimbursement arrangements (QSE HRAs).

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Topics: HIPAA, group health insurance, health reimbursement arrangements, HRA, Danielle Capilla, 21st Century Cures Act, Qualified Small Employer HRA, benefits enrollment, women's preventive services