United Benefit Advisors Insight and Analysis Blog

Two PPACA Taxes Might Get the Ax

Posted by: Jennifer Stanley    May 12, 2015 12:00:00 PM

Health Insurance Providers Fee

Section 9010 of the Patient Protection and Affordable Care Act (PPACA) imposes a fee on each covered entity engaged in the business of providing health insurance for United States health risks. This is known as the Health Insurance Providers (HIP) fee or the Health Insurers Tax (HIT) tax. The first filings were due from covered entities by April 15, 2014, and the first fees were due September 30, 2014. Self-insured plans are not covered entities for the purpose of the HIP Fee. The HIP fee is an important revenue source for PPACA, amounting to $8 billion in 2014 and rising to $14.3 billion by 2018. While fully insured plans are not directly responsible for the HIP fee, the Congressional Budget Office was correct when it indicated that it would be “largely passed through to consumers in the form of higher premiums.” Some premiums have increased as much as 4.5%.

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Topics: PPACA Affordable Care Act, Jennifer Kupper, excise tax, Cadillac Tax, Health Insurers Tax, Health Insurance Providers fee

Potential Employer Penalties under the Patient Protection and Affordable Care Act

Posted by: Danielle Capilla    May 7, 2015 12:00:00 PM

Employers that do not meet the requirements of the Patient Protection and Affordable Care Act (PPACA) need to be concerned about several potential penalties. Two significant penalties include the excise tax, which can be as much as $100 per affected individual per day, and the penalties that larger employers must pay if they do not meet their employer-shared responsibility/play or pay obligations.

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Topics: PPACA Affordable Care Act, Play or Pay, excise tax, employer shared responsibility, IRS Form 8928

Proposed Rule on Wellness Programs under the Americans with Disabilities Act

Posted by: Danielle Capilla    May 5, 2015 12:00:00 PM

Federal agencies recently released a Proposed Rule to amend regulations and provide guidance on implementing Title I of the Americans with Disabilities Act (ADA) as it relates to employer wellness programs.

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Topics: discrimination, wellness incentives, wellness programs, PPACA Affordable Care Act, Group health plans, Americans with Disabilities Act, ADA

Top 5 Questions about Medicare Secondary Payer Rules

Posted by: Danielle Capilla    Apr 28, 2015 12:00:00 PM

Under federal regulations, Medicare is a secondary payer for many individuals who have an employer group health plan available to them, either as an employee or the dependent spouse or child of the employee. Generally the Medicare Secondary Payer rules prohibit employers with more than 20 employees from in any way incentivizing an active employee age 65 or older to elect Medicare instead of the group health plan, which includes offering a financial incentive. Although premium payment arrangement rules under the Patient Protection and Affordable Care Act (PPACA) provide a limited circumstance for reimbursing Medicare premiums, this option is not feasible for employers with more than 20 employees due to Medicare Secondary Payer rules.

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Topics: PPACA Affordable Care Act, Group health plans, Medicare, Medicare secondary payer

SCOTUS and the Future of U.S. Health Care

Posted by: Peter Freska    Apr 14, 2015 12:00:00 PM

The Patient Protection and Affordable Care Act (PPACA), commonly referred to as “Obamacare,” was signed into law with the intention of decreasing the number of uninsured Americans and reducing the overall costs of health care in the United States. In order to increase the number of U.S. citizens covered, a number of mechanisms including mandates, subsidies, and tax credits became effective beginning January 1, 2014. The federal health care law also contains many reforms aimed at improving health care outcomes and streamlining the delivery of care. While this reform may be appealing, there are many concerns as to its viability, beginning with the increased number of people covered to effective reduction of health care costs. In the latest arguments for or against PPACA, the Supreme Court of the United States (SCOTUS) heard arguments on the legality of who is able to provide subsidies to those who qualify for subsidies. This lawsuit contends that subsidies are illegal unless a state has set up its own health insurance exchange. The charge is based on wording in the law, which states that subsidies are for health coverage obtained on an “Exchange established by the State under section 1311.”

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Topics: health care reform, premium subsidies, Medicaid, PPACA Affordable Care Act, U.S. Supreme Court, Medicare, single-payer system, Obamacare

Congress Taking (Small) Steps for Employee Wellness Programs

Posted by: Jennifer Stanley    Apr 9, 2015 12:00:00 PM

The Patient Protection and Affordable Care Act (PPACA) specifically encourages and promotes the expansion of wellness programs in both the individual and group markets. In the individual market, the secretaries of the departments of Health and Human Services (HHS), Treasury, and Labor are directed to establish a pilot program to test the impact of providing at-risk populations who utilize community health centers an individualized wellness plan that is designed to reduce risk factors for preventable conditions as identified by a comprehensive risk-factor assessment. Results will be compared against a controlled group.

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Topics: wellness, employee benefits, wellness programs, PPACA Affordable Care Act, 2014 Health Plan Survey

Supreme Court Hears Oral Argument in Subsidy Eligibility Battle

Posted by: Danielle Capilla    Apr 2, 2015 12:00:00 PM

Supreme Court Hears Oral Argument in Subsidy Eligibility BattleOn March 4, 2015, the U.S. Supreme Court heard oral arguments in King v. Burwell, a case that centers on the meaning of statutory language in the Patient Protection and Affordable Care Act (PPACA). At question in the case is whether or not the Internal Revenue Service (IRS) may issue regulations to extend tax-credit subsidies to coverage purchased through health Exchanges established by the federal government via the Department of Health and Human Services (HHS) under Section 1321 of PPACA.

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Topics: health insurance exchanges, PPACA Affordable Care Act, Play or Pay, health care subsidies, employer shared responsibility, tax-credit subsidy

PPACA’s Impact on How CDHPs and HSAs Work Together

Posted by: Bill Olson    Mar 31, 2015 12:00:00 PM

Employer health savings account (HSA) funding strategies have changed in recent years in response to the Patient Protection and Affordable Care Act (PPACA) and its impact on employer-sponsored health insurance plans. Employers are contributing less, on average, to HSAs and the increase in popularity of cost-saving consumer-driven health plans (CDHPs) has also had a major impact on how employers use these accounts.

In 2014, employees saw a 10 percent decrease in their average single HSA employer contribution from the previous year, from $574 in 2013 to $515 in 2014, according to new data released from the 2014 UBA Health Plan Survey, the largest health benefits survey in the nation. Average family contributions also decreased 7 percent during the same period, from $958 to $890.

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Topics: health plan benchmarking, CDHPs, PPACA Affordable Care Act, health savings account, HSA, consumer-driven health plan, 2014 Health Plan Survey, HSA funding

Final Rule Issues Standards for Insurers and Marketplaces in 2016

Posted by: Linda Rowings    Mar 24, 2015 12:00:00 PM

Recently, the Centers for Medicare and Medicaid Services and the Department of Health and Human Services issued a Final Rule with standards for insurers and Marketplaces in 2016, covering topics such as transparency in health insurance rate increases, formulary drug lists, drug mail order opt out provisions, determination of minimum value, and benefits discrimination. Open enrollment for the 2016 benefit year will begin on November 1, 2015, and end on January 31, 2016.

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Topics: PPACA, essential health benefits, PPACA Affordable Care Act, Transitional Reinsurance Fee, cost-sharing limit, transparency in health insurance rates, insurance Marketplace, benefits discrimination

Highlights of Employer and Insurer Reporting Requirements

Posted by: Linda Rowings    Mar 3, 2015 12:00:00 PM

The Patient Protection and Affordable Care Act (PPACA) provides that individuals who do not have minimum essential (basic medical) coverage will owe a penalty unless they qualify for an exemption. Employers with 50 or more employees that do not offer affordable, minimum value coverage to their full-time employees also will owe a penalty. In addition, individuals who have lower incomes and meet other requirements may be eligible for advance tax credits to help pay for health coverage if they purchase coverage through a Marketplace. The Internal Revenue Service (IRS) is generally responsible for verifying that individuals have the required minimum essential coverage, individuals who request premium tax credits are entitled to them, and large employers are meeting their shared responsibility (play or pay) obligations. The IRS will be using IRS Forms 1094 and 1095 to gather the information it needs to administer penalties on those who owe them and to verify that tax credits are accurate.

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Topics: PPACA Affordable Care Act, IRS Form 1095, IRS Form 1094, PPACA reporting, minimum essential coverage