Find out everything you need to know about health care reform.
Be ready for health care reform. We can help you understand what to do to comply with the Affordable Care Act and plan for what's ahead.
Research findings and examine the issues impacting employee benefits trends and attitudes. Leverage these insights for your business.
Video explanations and tools cover important details and health care changes.
There have been some big changes made to health care and more are on the way.
Click the milestones to explore how the changes might affect you.
If you offer your workforce health insurance and employ fewer than 25 full-time workers (or 50 part-time workers), your business may be eligible for the Small Business Health Care Tax Credit.View Source
SIMPLE cafeteria plans are a new way for small businesses with 100 or fewer employees to save money. These plans allow employees to pay their portion of health insurance premiums and other eligible benefits, such as contributions to flexible spending accounts, with pre-tax dollars. As an employer, you can take advantage of this option to save on the employer portion of FICA, FUTA and workers’ compensation insurance premiums.View Source
Tax-favored plans, including health flexible spending arrangements (FSAs) and health reimbursement arrangements (HRAs), cannot be used to reimburse over-the-counter medicines.View Source
Non-grandfathered group health plans are required to offer preventive coverage to women without cost-sharing for plan years beginning on or after August 1, 2012. Certain religious employers are exempt from the requirement to offer contraceptive coverage, and others may qualify for a one-year delay or special accommodation.View Source
Major medical insurers that did not meet the new medical loss ratio (MLR) requirements were required to issue rebates to policyholders by August 1, 2012. In most cases, it is the employer’s responsibility to distribute the participant portion within three months of receiving the rebate. If your plan was due a rebate, you should have received it by now and may need to distribute employee portions. The details on distribution depend on the type of plan offered (e.g., church plan, ERISA, etc.). In the future, any rebate due must be paid by August 1 of each year.View Source
Major medical insurers began sending all benefits enrollees and applicants a new summary-of-benefits booklet and coverage notice to explain their benefit plans and coverage. If your business has a self-funded plan, you will be required to provide the new summary for annual enrollment periods on or after September 23, 2012, as well as all other enrollments for plan years beginning on or after January 1, 2013.View Source
Starting with plan years ending on or after October 1, 2012, issuers and plan sponsors are required to pay a new fee for each covered beneficiary, with the fee going to the PCORI fund. The funds will help contribute to research that evaluates and compares health outcomes and clinical effectiveness, and the risks and benefits of two or more medical treatments and/or services. Since the fee is treated as an excise tax, it is filed through IRS Form 720. The PCORI fee is $1 per covered beneficiary for the first year and is due July 31, 2013, for the first year.View Source
The ACA limits the amount of participant pre-tax dollars that can be used to cover health expenses through flexible spending accounts (FSAs).View Source
All employers that issued at least 250 Form W-2s in 2011 will need to report the value of health care coverage that employees participated in during the 2012 plan year on the employee’s Form W-2. Some items, such as stand-alone dental, vision and health savings account contributions, are excluded from this reporting requirement. Although the value must be reported, it is not taxable for the business or employee.View Source
Employers will no longer be able to deduct retiree drug expenses for which they receive a Medicare Part D retiree drug subsidy payment.View Source
Employers subject to the Fair Labor Standards Act are required to notify employees of the Health Insurance Marketplace and potential eligibility for premium credits. Aflac has created the “Health Care Reform Communications Toolkit” to help businesses comply with this communications requirement.View Source
Effective 2014, small businesses and individuals will have the opportunity to participate in the federal- and state-facilitated Health Insurance Marketplace. Specific information by state can be found at healthcare.gov.View Source
During the first three years of insurance market reforms (2014–2016), a temporary reinsurance program for the individual insurance market will be funded by a required contribution from all group major medical plans. The per capita amount is paid for each enrollee by the insurer or the self-funded plan.View Source
Small-business tax credits will expand to 50 percent of a small business’s premium costs for two consecutive years. These credits are available to businesses with average wages between $25,000 and $50,000, and fewer than 25 full-time workers (or 50 part-time workers) that offer health insurance through the Small Business Health Options Program (SHOP) Marketplace.View Source
Pre-existing condition exclusions will no longer be permitted. There will be no annual dollar limits on benefits. Small-group fully insured plans will be required to offer essential health benefits (does not apply to grandfathered plans). Limits will be placed on out-of-pocket expenses (does not apply to grandfathered plans). Small-group fully insured plans will have limits on deductibles (does not apply to grandfathered plans). Health insurers will be subject to modified community ratings and guaranteed-issue requirements. Waiting periods in excess of 90 days will be prohibited.
Employers with at least 100 full-time equivalent employees must offer affordable, minimum value health coverage to at least 70 percent of their full-time employees and their dependents, unless the employer qualifies for 2015 dependent coverage transition relief, or face a penalty.View Sources
Internal Revenue Service (2013). Transition Relief for 2014 Under §§ 6055 (§ 6055 Information Reporting), 6056 (§ 6056 Information Reporting) and 4980H (Employer Shared Responsibility Provisions). Accessed on August 21, 2013.
Internal Revenue Service (2014). Questions and answers on shared responsibility provisions under the Affordable Care Act. Accessed on February 25, 2014.
The U.S. Supreme Court Case King vs. Burwell is a high stakes lawsuit concerning the legality of health care subsidies. The case, born out of two conflicting federal court rulings in the summer of 2014, could have serious implications for the Affordable Care Act (ACA) and individuals who are insured through federal health care exchanges. Arguments were heard on March 4, 2015, and a ruling is expected in late June 2015.
Open enrollment for individuals and businesses begins for state and federal exchanges for coverage that begins January 1, 2016.
Employers with at least 50 full-time equivalent employees must offer affordable, minimum-value health coverage to at least 95 percent of their full-time employees and their dependents or face a penalty.View Source
Your business will be required to report information regarding the health coverage of your employees, including basic employee data, dates and type of coverage; cost-sharing; and any other information required by the IRS. These requirements apply to coverage offered on or after January 1, 2015, but the first report will not be due until 2016.View Source
A tax will be imposed on insurers and employers with self-funded health plans with annual premiums that exceed $10,200 for individuals and $27,500 for multiple coverage. The Cadillac tax is 40 percent of the excess of the annual value of a health plan’s cost above the threshold amounts set forth above.View Source
July 17, 2015
As they struggle to become financially stable, state-based health insurance marketplaces are lagging behind the federally-facilitated marketplace and are likely to continue to do so in the near future.Read the Article
July 16, 2015
With 24 Republican senators up for reelection in November 2016, not to mention the presidential election, there is so much set to change for both public and private exchanges.Read the Article
July 20, 2015
The Internal Revenue Service (IRS) is starting to estimate how well public exchange plan users are following the new health insurance premium tax credit reporting rules.Read the Article
July 20, 2015
Since 2008, benefits lawyers have been telling employers and health insurers about the kinds of regulatory changes the Obama administration might make.Read the Article