United Benefit Advisors Insight and Analysis Blog

Contraception Mandate Rolled Back for Employers

Posted by: Danielle Capilla    Oct 19, 2017 9:30:00 AM

Two tri-agency (Internal Revenue Service, Employee Benefits Security Administration, and Centers for Medicare and Medicaid Services) Interim Final Rules were released and became effective on October 6, 2017, and will be published on October 31, 2017, allowing a greater number of employers to opt out of providing contraception to employees at no cost through their employer-sponsored health plan.

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Topics: contraception coverage, group health insurance, Affordable Care Act

President Trump Ends ACA Cost Sharing Reductions

Posted by: Danielle Capilla    Oct 17, 2017 9:30:00 AM

On the evening of October 12, 2017, President Trump announced that cost sharing reductions for low income Americans in relation to the Patient Protection and Affordable Care Act (ACA) would be stopped. The Department of Health and Human Services (HHS) has confirmed that payments will be stopped immediately. While there is no direct impact to employers at this time, UBA will continue to educate employers about changes in the law and its Health Plan Survey will continue to track group health plan rates over time as insurance companies potentially seek to recoup lost revenue. It is anticipated at least some state attorneys general will file lawsuits to block the ending of the subsidy payments, with California Attorney General Xavier Becerra stating he is prepared to file a lawsuit to protect the subsidies.

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Topics: health insurance exchanges, Cost-Sharing, group health insurance, Affordable Care Act

October 2017 Executive Order on Healthcare

Posted by: Danielle Capilla    Oct 13, 2017 10:59:15 AM

On October 12, 2017, the White House released an Executive Order, signed by President Trump, titled "Promoting Healthcare Choice and Competition Across the United States."

It is important to note that the Executive Order (EO) does not implement any new laws or regulations, but instead directs various federal agencies to explore options relating to association health plans, short term limited-duration coverage (STLDI), and health reimbursement arrangements (HRAs), within the next 60 to 120 days.

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Topics: ACA, health reimbursement arrangements, Affordable Care Act, association health plans

IRS Releases Draft Forms and Instructions for 2017 ACA Reporting

Posted by: Danielle Capilla    Oct 5, 2017 8:30:00 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.

Reporting is required by employers with 50 or more full-time (or full-time equivalent) employees, insurers, or sponsors of self-funded health plans, on health coverage that is offered in order for the Internal Revenue Service (IRS) to verify that:

  • Individuals have the required minimum essential coverage,
  • Individuals who request premium tax credits are entitled to them, and
  • ALEs are meeting their shared responsibility (play or pay) obligations.

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Topics: Affordable Care Act, applicable large employers, ACA reporting

IRS Roundup: What Employers Need to Know about the Latest ACA Notices

Posted by: Danielle Capilla    Sep 28, 2017 9:30:00 AM

In spite of the recent efforts by Congress to change or repeal the ACA, its provisions are still in effect. The IRS has issued continuing guidance on the affordability rate for coverage, the employer shared responsibility provisions and reporting, and the individual mandate provision.

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Topics: employer shared responsibility, Affordable Care Act, IRS reporting

DOL Asks for MHPAEA Related Comments; Clarifies Eating Disorder Benefit Requirements

Posted by: Danielle Capilla    Jun 28, 2017 9:30:00 AM

Earlier this month, the Department of Labor (DOL) provided an informational FAQ relating to the Mental Health Parity and Addiction Equity Act (MHPAEA) and the 21st Century Cures Act (Cures Act). This is the DOL's 38th FAQ on implementing the Patient Protection and Affordable Care Act (ACA) provisions and related regulations. The DOL is requesting comments on a draft model form for participants to use to request information regarding nonquantitative treatment limitations, and confirms that benefits for eating disorders must comply with the MHPAEA. Comments are due by September 13, 2017.

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Topics: ACA, Affordable Care Act, Mental Health Parity and Addiction Act, mental health, 21st Century Cures Act

What Happens to Coverage When Employees Reduce Their Hours?

Posted by: Danielle Capilla    Jun 13, 2017 9:30:00 AM

The Section 125 cafeteria plan regulations and the Patient Protection and Affordable Care Act (ACA) require employers to take certain actions when an employee reduces hours.

Consider this scenario: An employer has an employee who is reducing hours below 30 hours per week. The employee is performing the same job and duties. The employee was determined to be full-time during the most recent measurement period. The employee is currently in a stability period.

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Topics: ACA, cafeteria plan, Affordable Care Act, Section 125 plan, reduction in hours

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

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