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Breaking News – 12-19-2019

Congress Repeals the Cadillac Tax and Health Insurance Tax

Congress has voted to fully repeal the Cadillac (excise) Tax and the Health Insurance Tax. The legislation fully repeals the Cadillac Tax and repeals the HIT effective January 1, 2021, which means the HIT will still be in place for 2020. According to the Congressional Budget Office, repealing the Cadillac Tax will save consumers $197 billion, and the HIT repeal will save consumers $150 billion!

Individual Mandate Is Found Unconstitutional

The United States Court of Appeals for the Fifth Circuit issued its decision in the Texas v. United States case. The case challenged the constitutionality of the ACA's individual mandate in light of the Tax Cuts and Jobs Act of 2017, which zeroed out the individual mandate penalty. The appellate court was reviewing the lower court's ruling that found that the individual mandate, with no accompanying tax penalty, is unconstitutional and that the individual mandate is such an essential part of the ACA that the ACA cannot function without the individual mandate in place.
In the appellate court's ruling, it agreed that the individual mandate is unconstitutional because it can no longer be read as a tax, and there is no other constitutional provision that justifies this exercise of congressional power. However, when reviewing whether the individual mandate could be separated from the rest of the ACA, the appellate court sent that question back to the district court to provide additional analysis of the provisions of the ACA as they currently exist that was not provided in the lower court's previous decision.
However, this ruling is not final and is expected to be engaged in appeals for the next several months, which will likely culminate in a hearing before the Supreme Court. This means that the ACA continues to be the law of the land and compliance with the ACA is still being enforced. Coverage for the 2020 plan year remains unaffected by the ruling.

Source- National Association of Health Underwriters (NAHU)


NAHU Coalition Releases New Materials on the Risks of Public Option – 8-16-2019

The Partnership for America's Health Care Future released a series of new videos on the differences (and lack thereof) between Medicare-for-All and Medicare Buy-In. The overall campaign encourages meaningful reforms to the nation’s healthcare system that preserve market-based, employer-provided healthcare rather than attempting to implement a disruptive one-size-fits-all system. NAHU is a member of the Partnership, which includes industry stakeholders opposed to Medicare-for-All or similar single-payer programs and committed to delivering affordability, expanding options, improving access, and fostering innovation in the healthcare system.

The Partnership highlighted a new study by Navigant Consulting that reveals the intense risk that a public option system would pose for rural hospital systems. “As many as 55% of rural hospitals, or 1,037 hospitals across 46 states, could be at a high risk of closure under the public option,” the statement reads. “The implementation of a public option on health exchanges presents significant risks to rural hospitals and communities nationwide. Even with a conservative estimate, the public option would exacerbate the already significant financial risks rural hospitals face. If a substantial percentage of the commercial population were to shift to reimburse at Medicare rates, a large proportion of high-risk hospitals would see a grave threat to their viability, and hundreds of rural hospitals presently at lower levels of risk would move to the high-risk category.”

The Partnership also released a statement in response to former Vice President and Democratic presidential candidate Joe Biden’s public option proposal. Biden is currently leading the crowded Democratic field in most public opinion polls. “We strongly believe that every American deserves access to high-quality health care, and we agree with the majority of Americans who believe the best way to achieve this is to build and improve upon what is working, while coming together to fix what isn’t,” Lauren Crawford Shaver, the Partnership’s executive director, said in the statement. “Unfortunately, Vice President Biden’s proposal for a new government insurance system through a ‘public option’ would undermine the progress our nation has made and ultimately lead our nation down the path of a one-size-fits-all health care system run by Washington. From driving up premiums in the private market, to threatening our nation’s already at-risk hospitals, to diminishing Americans’access to the quality care they need, research warns that such an approach could be disastrous for patients and consumers.”

The new videos, “Closer Look” and “Same Thing,” highlight the potential effects of a public option system and how the impacts would not stray far from the impacts of a Medicare-for-All system. The videos compare Medicare-for-All and Medicare Buy-In, emphasizing that both systems could lead to higher taxes, higher premiums, and lower quality of care. “Closer Look” stresses the impact of more Americans buying into Medicare, and notes that this could destabilize the Medicare market and worsen the system that serves seniors so well. The Partnership argues that Medicare-for-All and Medicare Buy-In do not offer real answers to these questions, such as how to lower costs and protect patient choice, but instead only creates more problems.

Source – National Association of Health Underwriters (NAHU)

Legislation Introduced to Allow HSAs for Medicare Beneficiaries – 07-19-2019

On Wednesday, Representatives Ami Bera (D-CA) and Jason Smith (R-MO) introduced H.R. 3796, the Health Savings for Seniors Act, NAHU-supported legislation that would allow seniors covered under Medicare to continue contributing to HSAs after age 65. Specifically, the bill allows anyone enrolled in Medicare, either traditional fee for service or Medicare Advantage plans (including Medicare Advantage MSA) to open an HSA and fund it to the HSA individual maximum and allows those who already have an HSA to be able to fund their account after they enroll in Medicare. It also aligns rules for all HSAs with current beneficiaries, and allows working seniors to enroll in Medicare and still be HSA eligible, even if they have employer sponsored-coverage.

This bill follows efforts last year to enact legislation to similarly expand HSAs. House Republicans initially offered a package termed “Tax Cuts 2.0,” that would have expanded on the tax cuts enacted under the 2017 Tax Cuts and Jobs Act. Lawmakers sought to include several HSA-related provisions that NAHU continues to advocate, including provisions from H.R. 6311 that would allow both spouses to make catch-up contributions to the same HSA, allow working seniors eligible for Medicare Part A to contribute to HSAs and let balances on FSAs to be carried over each year. H.R. 6311 would have also allowed all individuals purchasing plans on the individual market to purchase a lower premium “copper plan,” as well as allowing “catastrophic” and “bronze” plans in the individual and small group markets to qualify for HSA contribution.

A separate bill, H.R. 6199 was passed by a 277-142 bipartisan vote and would have modernized HSAs by allowing some over-the-counter medicines to count as qualified medical expenses, increase flexibility for retail and onsite clinics, and allowing plans to provide coverage before the deductible is met. In addition, the legislation would also give spouses more opportunities to contribute to their partner’s HSA. Unfortunately, both of these bills were not ultimately enacted into law after failing to pass both chambers prior to the end of the congressional session.

Source: National Associate of Health Underwriters (NAHU)


Federal agencies to increase healthcare price and quality transparency – 06-25-2019

President Trump signed an executive order this afternoon directing federal agencies to increase healthcare price and quality transparency. The order specifically directs the of Departments of Labor, Treasury and Health and Human Services to issue guidance and propose regulations that would disclose negotiated rates, cost-of-care and de-identified federal healthcare data, and to expand the availability of Health Savings Accounts. The order does not immediately trigger any new federal policies, except for the specific instructions to the federal agencies to develop regulatory guidance. NAHU will work with these agencies to influence the regulations and ensure that any rules that are promulgated are in the best interest of consumers.
The order includes five main provisions instructing federal agencies to issue guidance that would:

  • require hospitals to disclose information about their negotiated rates in a format that's understandable and usable by patients.
  • require insurance companies to provide patients with information about cost of care, including out-of-pocket costs, before they receive services.
  • develop a comprehensive roadmap for consistent, limited, consumer-centric quality metrics.
  • disclose de-identified federal healthcare data that protects patient and consumer privacy, enables transformation of the healthcare marketplace, and allows researchers to develop tools and analytics to allow patients to be at the center of their healthcare.
  • expand the availability of HSAs to cover direct primary care arrangements and healthcare sharing ministries, include more preventive services and products that can be covered in the deductible period, and issue guidance on the amount of funds that can be carried over at the remainder of the year for FSAs.  

Source: National Association of Health Underwriters

Final Notice of Benefit and Payment Parameters for 2020 – 06-06-2019

Recently, the Department of Health and Human Services (HHS) released its final Notice of Benefit and Payment Parameters for 2020. This proposed rule describes benefit and payment parameters under the Affordable Care Act (ACA) that would be applicable for the 2020 benefit year.

Notable Changes for 2020

The out-of-pocket maximum (OOPM) will increase.

  • OOPM: $8,150 for self-only coverage and $16,300 for family coverage
  • Affordability threshold: 8.24% of household income

Source: HR360

NAHU Fast Facts – 05-03-2019

  • The House Rules Committee held a first-ever hearing on Medicare for All. NAHU submitted comments opposing the legislation and signed onto other comments in opposition submitted by our coalition partners.
  • The Congressional Budget Office released a report on key considerations for establishing a single-payer healthcare system, although it is not a direct analysis of current Medicare-for-All legislation, nor did it provide an estimated total cost to the federal government.
  • The Department of Justice, 18 Republican attorneys general (state plaintiffs) and the individual plaintiffs in the suit filed appellate briefs in Texas v. U.S., arguing that the entire ACA should be overturned, upholding the ruling last December by a U.S. District Court. The group of Democratic attorneys general has three weeks to file their countering arguments, and oral arguments in the appeal will begin the week of July 8.
  • Representatives Anthony Brindisi (D-NY) and Kenny Marchant (R-TX) introduced H.R. 2447, legislation to fully repeal the ACA's Health Insurance Tax.

Source: National Association of Health Underwriters (NAHU)

Medicare For All – 03-18-2019

This past week, members of Congress who are in favor of Medicare for All introduced legislation to move our healthcare system to a single-payer system that would limit choice, increase waiting times and eliminate Medicare as we know it. And in exchange for sacrificing control of their healthcare, Americans would pay trillions of dollars in new taxes.

No one would have a choice in the matter. The bill would outlaw private insurance coverage. The more than 180 million people with employer-sponsored insurance plans, the 20 million people who purchase coverage on the individual market and the 20 million people with privately administered Medicare Advantage plans would all find themselves in a new, one-size-fits-all government plan.

Ensuring that everyone has access to health insurance is a laudable goal, but we can more easily achieve it by building on what works in our current system and fixing what doesn't.

Source: National Association of Health Underwriters (NAHU)

General News Update – 2-22-19

  • The U.S. spent $3.65 trillion on healthcare in 2018, which is about the size of Spain and Canada's economies combined. This is 4.4% higher than 2017. The rate of healthcare spending is growing faster than the economy, which means that these healthcare costs are coming out of people's paychecks.
  • According to CMS’s Office of the Actuary, U.S. healthcare expenditures will rise by an average of 5.5 percent between 2018 and 2027. During this time, Medicare spending is expected to increase 7.4 percent annually, while Medicaid and private insurance would rise 5.5 percent and 4.7 percent respectively.
  • The Emergency Department Review program started by Anthem in 2017 has made the insurance process even more complicated for consumers who have utilized emergency room services by scrutinizing whether they were necessary services, and if not, the consumer would be responsible for the bill. Many are concerned that this policy will cause people to avoid ER services even when they are required as a precaution against the billing.
  • States with expanded Medicaid programs are searching for ways to fund new enrollees in 2020 as the federal contribution to the program gradually decreases. Many states have implemented higher taxes on health providers or insurers, or have imposed so called “sin” taxes on the sale of alcohol or cigarettes.
  • Lawmakers in California have introduced legislation that would reinstate the individual mandate, which would require all state residents to have health insurance starting in 2020 or pay a penalty.

Source: National Association of Health Underwriters


Judge Rules ACA Unconstitutional – 12-18-2018

On December 14, U.S. District Judge Reed O'Connor released his ruling on the first of five counts in Texas v. United States. The case challenged the constitutionality of the ACA's individual mandate in light of the Tax Cuts and Jobs Act of 2017, which zeroed out the individual mandate penalty. Judge O'Connor's ruling was that the individual mandate, with no accompanying tax penalty, is unconstitutional. The decision also determined that the individual mandate is such an essential part of the ACA that the ACA cannot function without the individual mandate in place. As a result, his ruling finds the entire ACA invalid.
However, this ruling is not final and is expected to be engaged in appeals for the next several months, which will likely culminate in a hearing before the Supreme Court. This means that the ACA continues to be the law of the land and compliance with the ACA is still being enforced. Coverage for the 2019 plan year remains unaffected by the ruling.

Source: National Association of Health Underwriters

President Trump Signs Prescriptions Drug Gag Clause Legislation – 10-19-2018

On Wednesday, President Trump signed into law ;S. 2553, the Know the Lowest Price Act, and S. 2554, the Patient Right to Know Drug Price Act. The legislation was passed by the House and Senate last month with bipartisan support and will ban “gag clauses” that prevent pharmacists from telling customers when they can save money on their prescriptions by paying out of pocket for the retail price of the drug, rather than using their insurance and making the co-payment. These bills comprise portions of President Trump’s “America First” prescription drug initiative that were released as part of a blueprint to lower drug prices in May.

S. 2554 applies to private plans and would ban health insurers and group health plans from preventing pharmacists from telling consumers that it would be more cost effective to pay out of pocket, as opposed to paying their insurance co-payment. Meanwhile, S. 2553 addresses patients covered under Medicare Part D and Medicare Advantage plans and prohibits a prescription drug plan under Medicare from restricting a pharmacist from providing complete price information for a medication to a beneficiary.

The passage of both bills comes after multiple states had already taken action to stop the practice. Connecticut, Georgia, Maine and North Carolina passed legislation last year banning the practice of gag clauses. The success of these bans set the stage for 10 other states around the nation to introduce bills, which ultimately acted as a catalyst for federal legislation.

Souurce: National Association of Health Underwriters

Summary Plan Descriptions (SPD) – 05-02-2018

The Summary Plan Description or SPD is an important written document that a plan administrator must provide automatically and free of charge to participants of an ERISA-covered health benefit plan. The SPD provides information on when an employee can begin to participate in the plan, how service and benefits are calculated, when and in what form benefits are paid, and how to file a claim for benefits. 

Who Must Comply

The requirements apply generally to group health plans. A group health plan is an employee benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care to employees and their dependents directly or through insurance, reimbursement or otherwise.

Types of information covered in a SPD:

Provides plan participants and beneficiaries with information about their rights, benefits, and responsibilities under the plan and how it works, including:

  • Basic rights and responsibilities of participants under ERISA (model language is available--see 29 C.F.R. § 2520.102-3(t)(2));
  • Eligibility requirements;
  • Description of plan benefits and how to file a claim for benefits;
  • Applicable premiums, cost-sharing, deductibles and copayments; and
  • Notices and descriptions required under COBRA, HIPAA, and other health coverage laws.

Which Members Must Be Provided the SPD:

  • Each participant covered under the plan
  • Plan participants and beneficiaries, as well as the U.S. Department of Labor, or DOL, also have the right to obtain a copy of the SPD upon request

When is the SPD Due:

  • Within 90 days after the employee becomes covered under the group plan. (New plans have 120 days after becoming subject to ERISA to distribute the SPD.)
  • The SPD must be current within 120 days prior to the date of distribution, and must be accompanied by any summary of material modification or change in information required to be included in the SPD which has not been incorporated into the document being furnished.

An updated SPD must be furnished every 5 years if changes are made to SPD information or the plan is amended. Otherwise, it must be furnished every 10 years.

Additional IRS Revision to HSA Family limit - 4-30-2018

IRS Revenue Procedure 2018-27 returns the annual limit for 2018 HSA family contributions to $6,900. This follows and supersedes Revenue Procedure 2018-18, which was published this past March.

The IRS acknowledged that the $50 reduction to the limit on HSA deductions for family HDHP coverage imposed “administrative and financial burdens.” The notice reflected that these burdens fell on individuals who had already made the maximum contribution for the year based on the announcement made in 2017 (Revenue Procedure 2017-37), but also on employer plans where individuals had established annual salary reductions based on the $6,900 limit.

-National Association of Health Underwriters-

HSA Contribution Limit Adjustment – 03-09-2018

The IRS released Revenue Procedure 2018-10  which modifies and supersedes certain sections of Revenue Procedure 2017-58 and supersedes Revenue Procedure 2017-37 to reflect by new tax  law (pub. L no. 115-97 enacted December 22, 2017.  This law changed the annual inflation adjustment factor from the "Consumer Price Index" (CPI) to a new factor known as "chained CPI."  These changes are effective as of the beginning of 2018. 

As a result, the HSA family contribution limit has been affected for 2018.  The limit has been decreased from $6,900 to $6,850.  All the other contribution limits, HDHP limits and out-of pocket limits remain the same for 2018.

ACA's Individual Mandate - Still In Force - 2-9-2018

Posted on February 9, 2018 by nahucompliance

The new tax law passed by Congress and signed by the President does not repeal the individual mandate as many people have assumed. The tax law actually zeroes out the individual mandate penalty. And, importantly, this action takes effect in 2019.

The actual law text is:


(a) IN GENERAL.—Section 5000A(c) is amended—
     (1) in paragraph (2)(B)(iii), by striking ‘‘2.5 percent’’ and inserting ‘‘Zero percent’’, and
     (2) in paragraph (3)—
           (A) by striking ‘‘$695’’ in subparagraph (A) and inserting ‘‘$0’’, and
           (B) by striking subparagraph (D).
     (b) EFFECTIVE DATE.—The amendments made by this section shall apply to months beginning after December 31, 2018.

For individuals who question whether the IRS will continue to enforce the individual mandate, knowing that penalties will go away next year, only time will tell. For the 2018 tax filing season, the IRS has stated that they will not accept tax returns that omit information specifying whether an individual had coverage or whether they qualified for an exemption from the individual mandate.
Opinions are mixed on what effect no penalty assessment will have on how many people maintain health coverage. Employers may find that some employees will drop employer-sponsored coverage since the employees will no longer face a penalty if they don’t have coverage.

Some individuals may no longer purchase individual health insurance. But, the extent to which individuals purchased coverage to avoid the somewhat low individual mandate penalty is unknown.

One likely outcome is that there will be an uptick in adverse selection. Adverse selection occurs when individuals who believe that they will have medical expenses seek out or retain health insurance coverage when they might not otherwise do so. Until the extent of any adverse selection is understood, insurers are likely to be conservative in their pricing or in their decisions on which markets they will participate in.

Health Care Legislation Update - 2-2-2018

A major victory was achieved for health insurance recipients on Monday night in the continuing resolution that is keeping the federal government funded. The package included a moratorium in 2019 of the Health Insurance Tax on all plans and an additional two-year delay of the Cadillac Tax on employer-sponsored health insurance plans until 2022.

This is very good news for EVERYONE with health insurance!


Fast Facts From NAHU - 9-29-2017

  • HHS Secretary Dr. Tom Price resigned his position effective immediately. Acting Assistant Secretary for Health Don Wright will serve as acting secretary until a new nominee is confirmed by the Senate.
  • Citing a lack of support, Senate Republicans scrapped a vote of the Graham-Cassidy plan to repeal/replace the ACA. NAHU released a press statement expressing our concerns with the legislation and called for a returned focus on market stability.
  • Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) resumed bipartisan negotiations on legislation to stabilize markets ahead of the 2018 plan year, including possible temporary funding of the ACA's cost sharing reduction payments.
  • President Trump is expected to release an executive order next week to permit the sale of insurance across state lines, through a reinterpretation of ERISA.
  • A Tax Reform framework was released this week as lawmakers begin the process of overhauling the nation's Tax Code through the budget-reconciliation process. NAHU is closely monitoring negotiations as they relate to provisions governing employer-sponsored insurance.

-National Association of Health Underwriters-


The Senate Voted 49-51 to Reject the Health Care Freedom Act - 7-28-2017

Shortly after 1:30 a.m. today, the Senate voted 49-51 to reject the Health Care Freedom Act (HCFA), a "skinny repeal" of the ACA. The pared-down version was attempted after previous efforts to pass a more sweeping repeal of the law have failed. Senate Majority Leader Mitch McConnell (R-KY) began floating the idea early in the week before ultimately releasing the text of the bill at 10 p.m. Thursday, just two hours before the vote. Republican Senators Susan Collins (ME), Lisa Murkowski (AK), and John McCain (AZ) joined all Democrats in voting no, while all other Republicans voted in favor. With the failure of this vote, congressional Republicans will no longer be able to use the budget reconciliation process to repeal provisions of the ACA until the next fiscal year and will instead have to move legislation under regular order that would require 60 votes for passage in the Senate.

Until any legislation or regulations are formally enacted into law, the ACA remains the law of the land and all of its mandates, penalties, and enforcement remains in effect.

-National Association of Health Underwriters-

Questions About Passing The American Health Care Act Bill - 5-15-2017

With the passing of the American Health Care Act bill, questions abound.  Everyone should know that the bill is not law and it is NOWHERE NEAR BEING PERFECT.

It now goes to the Senate for revisions and additional polishing. It could be until this year end before we see what a final version would look like. Meanwhile, these are some talking points of the bill:

  • IT DOES NOT eliminate coverage for pre-existing conditions.
  • Carriers must provide guaranteed issue policies.
  • If you have a pre-existing condition and you live in a state that does not seek a waiver from the AHCA and the ACA’s rating system, you cannot be charged more than any other folks buying a new plan in your State.
  • Anyone on a plan cannot be dumped due to a pre-existing condition, nor charged more if a condition develops. If you change coverage, you will not be charged higher than others and this is true of waiver or non waiver states.
  • If you are uninsured and have a pre-existing condition, Congress is setting aside a fund to help with coverage. (Arguably not enough, but a work in progress)

We must all wait to see what the Senate does.  We are still a long way from “repeal and replace”.

The American Health Care Act what happens to Obamacare Now? 4-6-2017

The GOP pulled its Obamacare replacement bill before it could go to a vote on Friday, March 24. This begs the question… is that the end of the Affordable Care Act (ACA) repeal and replace plan? Will another bill be drafted?  The GOP appears to be drafting another bill as we speak.

As of right now there are many more questions than answers. Most answers and guidance will be coming in the future. What we do know is that the ACA remains in place as written. As of now nothing has changed.

Subsidies for those who qualify, essential health benefits, no pre-existing conditions remain in effect. The law, as written, remains the law.

Is the individual mandate still in effect?

Yes it is!  This has not changed. The existing healthcare reform law requires taxpayers to show that they have minimum essential coverage or pay a penalty. Consult a tax professional if you have questions.

If passed, The American Health Care Act (AHCA) would have eliminated the individual and employer mandates and the penalties associated with this provision of the law.

The IRS also provides ACA information and resources that may be helpful but does not serve as a replacement for professional guidance.

Will there be a 2018 open enrollment?

At this point, yes!  Every year since the ACA’s individual mandate took effect the open enrollment period for individual health insurance plans begins sometime in the fall. However, what will the Federal Marketplace look like? How will the Trump administration promote it?  Time will tell.

Need coverage now?

We encourage consumers to discuss their health insurance options with a licensed agent, visit www.healthcare.gov or call the Federal Marketplace 1-800-318-2596.

Again, all tax-related questions should be directed to a tax professional.


House Republicans Released the American Health Care Act - 03-10-2017

Source: National Association of Health Underwriters

Keep your plan extension – 03-06-2017

For small groups on non-grandfathered or “grand mothered” health plans. February 23rd 2017 CMS released new guidance that Transitional Relief/Keep your plan for small groups has been extended, yet again, for a extra year. The extended transitional policy will allow health insurance issuers, at their option, to continue group coverage to policies that would otherwise be terminated or cancelled providing that all policies end by December 31, 2018.

NAHU - Recommended ACA Reconciliation Repeals - 12-20-2016

The National Association of Health Underwriters is the leading professional association for health insurance agents, brokers, general agents, and consultants. NAHU members work every day with individuals, families, and employers of all sizes to help them purchase health insurance coverage and use that coverage in the best possible way. We are a dedicated group of more than 100,000 benefit specialists across the nation who advocate on behalf of our clients – American health insurance consumers.

The professional health insurance agent and broker community looks forward to the potential opportunities of working toward healthcare stability. To make the healthcare insurance market more efficient and more responsive to American employers and individual health consumers, we believe some changes need to be made to ensure access, choice, and affordability. As we look forward to the commencement of the 115th Congress, we anticipate that a reconciliation bill will be introduced to repeal budget-relevant provisions of the Affordable Care Act. We would like to respectfully recommend the repeal of the following items be included in any such reconciliation legislation:

Premium Tax Credits, Cost-Sharing Tax Credits, and Tax Credits to Territories
Repeal of these tax credits, but a suggested delay of the effective date to January 2019 in order to allow time for a replacement mechanism to be put in place to prevent a destabilization of the market by the immediate implementation of the repeal of these tax credits.

Small Business Tax Credit
Repeal of the small business tax credit with a suggested delay of the effective date to January 2019 to allow for any businesses currently qualifying from the small business tax credit to receive the benefit through the two-year maximum allotted for, and to prevent a destabilization of the small group market by the immediate implementation of the repeal of these tax credits.

Repeal of the Individual Mandate Penalty
In order to comply with the budget-relevant provisions of reconciliation, we request a repeal of the individual mandate penalty and further action to repeal the individual mandate in future legislation.

Repeal of Employer Mandate Penalty
In order to comply with the budget-relevant provisions of reconciliation, we request a repeal of the employer mandate penalty and further action to repeal the employer mandate in future legislation.

Repeal of Health Insurance Tax
Permanently eliminate the national premium tax (HIT tax) that will add more than $500 annually in costs to a typical family policy, with the total cost in 2016 of $11.3 billion.

Repeal Excise/Cadillac Tax
Permanently repeal the “Cadillac Tax,” which will impose a 40% excise tax on health plans that exceed certain cost thresholds beginning in 2020, following the two-year delay passed in December 2015.

Repeal of Medical Loss Ratio Requirement
A full repeal of the medical loss ratio requirement that carriers must abide by. Lifting the restriction that 80% of premium dollars must be spent on medical costs and 20% on administrative costs will provide relief to health insurance carriers struggling to meet the current restrictions, which will result in lowering premium costs and encouraging carriers to remain in the health insurance market. Since health insurance plans have already been approved for 2017, we suggest an effective date of January 1, 2018.

-National Association of Health Underwriters-

Preparing for ACA’s Employer Reporting in 2017 - 11-14-2016

Posted on November 14, 2016 by nahucompliance

Despite the results of the election, compliance with the ACA goes on, unless and until Congress takes action. Even then, odds are that changes to the ACA will take time to be implemented.

As such, with 2016 drawing to a close, employers are reminded that they have to calculate whether they will be an Applicable Large Employer (ALE) for 2017. An employer who is an ALE has employer shared responsibility requirements under the Affordable Care Act (ACA).

Employers with 50 or more full-time and full-time equivalent employees during the previous year are deemed to be ALEs (applicable large employers) who must report to the IRS and to employees. Therefore, employers who averaged 50 or more full-time and full-time equivalent employees during the calendar year 2015 are considered ALEs for 2016 and must report in 2017. Reporting in 2017 reflects enrollment and offers of coverage for 2016.

Employers who meet the ALE definition must report whether or not they offer an insured or self-insured health plan. Employers who meet the ALE definition must report even if they don’t offer any health coverage to employees. And, employers who are too small to be ALEs, but who offer self-insured health coverage, must report to the IRS regarding coverage offered to their employees.

The deadlines for reporting for coverage year 2016 are as follows:

  • Deadline to distribute forms to employees and covered individuals will be January 31, 2017
  • Deadline to file paper forms with the IRS will be February 28, 2017
  • Deadline to file electronically with the IRS will be March, 31, 2017.

The requirement to furnish the Form 1095-C is met if the form is addressed and mailed on or before the due date. Statements must be mailed or hand delivered unless the recipient has affirmatively consented to receive the statement electronically.
Employers can obtain an automatic 30-day extension of time to file forms to the IRS by completing Form 8809 — Application for Extension of Time To File Information Returns. This form must be filed in advance of the due date for the returns. It should be filed as soon as an employer determines that an extension of time is necessary.

An extension of time to furnish statements to employees is not automatic. A letter requesting an extension must be sent to the IRS. Instructions on filing for this extension are found on page 6 of the instructions for Forms 1094-C and 1095-C. The instructions can be found here.

Penalties for failing to report or making errors in reporting can be sizeable. It’s important to note that the IRS will no longer operate under a “good faith compliance” standard for this year’s reporting.

  • The penalty for failure to file a correct information return is $260 per return
  • The penalty for failure to provide a correct payee statement is $260 for each statement with the failure
  • There are limits to the size of the penalties unless there is “intentional disregard” to file and furnish the required statements.

Penalties may be waived due to reasonable cause. However, ignorance of the requirement to file is unlikely to gain a penalty waiver. As such, employers who discover that they should have filed this past year would be wise to file as soon as possible or consult with tax advisors.

Important Carrier Updates for the Individual 2017 Plan Year

As the Affordable Care Act nears the fourth annual open enrollment (November 1st – January 31st) many large carriers have announced they will be exiting some markets as of December 31st  or not participating in the 2017 plan year. This means that individuals will be left with fewer choices for insurance providers & plans in the upcoming year.

UnitedHealthcare will not participate or solicit major medical products on the Federal Exchange (Marketplace) or in the direct to the consumer sales, off exchange in Florida, for the 2017 plan year.

Humana will be reducing their direct to consumer, off exchange, 2017 footprint or remove it completely. Humana will have a very small offering on the Federal Exchange (only in certain counties) which have yet to release.

Aetna has announced that they will not solicit major medical products on the Federal Exchange in 2017. However, Aetna “may” continue to offer their direct to consumer major medical products and allow individuals to renew, off exchange, for the 2017 plan year.

This is a moving and evolving target. Please open and read all mail from the insurance company as to any offerings and enrollment process for 2017.

2016 Top 4 Changes to ‘Pay or Play’ 9-8-2016

The following are the top 4 changes to pay or play for 2016:

  1. Transition Relief Expired: The transition relief which delayed compliance with the pay or play requirements for ALEs with 50 to 99 full-time employees (including FTEs) in 2015 is now expired for employers with calendar year health plans. For ALEs with non-calendar year health plans, this transition relief, along with the transition relief for dependent coverage, continues to apply for any calendar month during the 2015 plan year that falls in 2016.
  2. New Affordability Threshold: If an employee's share of the premium for employer-provided coverage in 2016 would cost the employee more than 9.66% (formerly 9.56%) of his or her annual household income, the coverage is considered unaffordable to that employee. Employers offering unaffordable coverage may be subject to a pay or play penalty.
  3. Coverage Thresholds Increased: For 2016, ALEs will now be liable for a penalty if they:
    • Do not offer health coverage or offer coverage to fewer than 95% (formerly 70%) of their full-time employees (and their dependents), and at least one full-time employee receives a premium tax credit; or
    • Offer health coverage to at least 95% (formerly 70%) of their full-time employees (and their dependents), but at least one full-time employee receives a premium tax credit.
  4. Increased Noncompliance Penalties: For 2016, the general annual penalty for ALEs that do not offer coverage or offer coverage to fewer than 95% of their full-time employees (and their dependents) is $2,160 (formerly $2,080) per full-time employee, minus up to 30 full-time employees. For ALEs offering coverage to at least 95% of their full-time employees (and their dependents), the general annual penalty is $3,240 (formerly $3,120) per full-time employee that receives a premium tax credit.

Check out our Pay or Play section for valuable calculators and a toolkit for employers.

Health Reimbursements Arrangements Are Not for Wimps!

HRAs, as they are lovingly called, have undergone a major transformation over the last six years due to the ACA. With all the guidance coming out from different sources, it’s hard to keep track, let alone stay compliant. One day you can use them to reimburse premiums. The next you’re told you can’t by the IRS, but there are still those in the marketplace that said you could. Then we had to modify how HRAs were “integrated” into our group health plans. Because if they weren’t, you might be subject to a penalty for not offering minimum essential coverage. Now there are calculations to consider with HRAs regarding affordability. While all of this “new” guidance is in effect, employers and their advisors are still trying to build compliant plan designs with HRAs, FSAs and HSAs, working together.

Obama Administration Releases Extensive New Health Insurance Market Requirements 3-7-2016

On the evening of February 29, CMS released almost 700 pages of regulatory guidance related to implementation of the ACA.. These documents cover hundreds of topics spanning virtually all aspects of the American private and public health coverage systems. Most of the new rules will be effective for the 2017 coverage year on forward, although some provisions are effective sooner.

ER Individual Pay Reminder 9-30-2015

Important Reminder for Employers who help pay employees individual health insurance premiums

The Affordable Care Act specifically prohibits you from paying insurance premiums for your employees’ individual health plans.  It makes no difference whether paid with pre or post tax dollars. The fine is stiff:  $100 per employee per day.  See IRS Notice 2013-54 & FAQ 4.16.15; DOL Notice 2013-13 & FAQ 11.6.14. The IRS provided “Transition Relief” to all small employers who had these types of payment arrangements from January 1, 2015 -June 30, 2015.  The relief has now ended.

What can you do now to comply with this provision of ACA?

  1. Provide group health insurance.  Premiums are a tax deductible business expense and non includable as taxable wages to your employees.
  2. Grossing up taxable wages is generally allowed.  This is an expensive solution for both you and your staff due to the extra taxes due.  This solution cannot be tied to the health plan and employees do not have to use the wage increase for insurance premiums.

Employer Medicare Reimbursements 9-30-2015

Can I reimburse my employees for their Medicare Premiums?

The quick answer is Yes ~ BUT ONLY IF you have two or more employees on Medicare, PLUS a Group Insurance plan for your employees.  See the details and four conditions below.  Call me if you want to review.  Be very careful ~ Transition Relief has ended.  The IRS penalties are stiff under the Affordable Care Act.  ~ Carolyn

Medicare Premium Reimbursement Arrangements for Employers

An arrangement under which an employer reimburses (or pays directly) some or all of Medicare Part B or Part D premiums for employees constitutes an employer payment plan, and if such an arrangement covers two or more active employees, is a group health plan subject to the market reforms.

Small Employer Transition Relief Extends to Medicare Premiums

An excise tax will not be asserted for any failure to satisfy the ACA's market reforms by employer payment plans sponsored by small employers that pay, or reimburse employees for Medicare Part B or Part D premiums:

  1. For 2014, for employers that qualify as small employers for 2014; and
  2. For January 1 through June 30, 2015, for employers that qualify as small employers for 2015.

After June 30, 2015, such employers may be liable for the excise tax. Eligible employers are not required to file IRS Form 8928 (regarding failures to satisfy requirements for group health plans, including the ACA's market reforms) solely as a result of having these employer payment plans for the time periods above.

Medicare Premium Reimbursement Arrangements May Be Integrated With Other Group Health Plan Coverage to Satisfy the ACA's Requirements

An employer payment plan may not be integrated with Medicare coverage to satisfy the market reforms because Medicare coverage is not a group health plan. However, an employer payment plan that pays for or reimburses Medicare Part B or Part D premiums may be integrated with another group health plan offered by the employer to satisfy the annual dollar limit prohibition and preventive services requirements if:

  1. The employer offers a group health plan (other than the employer payment plan) to the employee that does not consist solely of excepted benefits and offers coverage providing minimum value;
  2. The employee participating in the employer payment plan is actually enrolled in Medicare Parts A and B;
  3. The employer payment plan is available only to employees who are enrolled in Medicare Part A and Part B or Part D; and
  4. The employer payment plan is limited to reimbursement of Medicare Part B or Part D premiums and excepted benefits, including Medigap premiums.

Note: To the extent such an arrangement is available to active employees, it may be subject to restrictions under other laws such as the Medicare secondary payer provisions.

Medicare Premium Reimbursements & Federal Nondiscrimination Laws

According to an informal discussion letter from the U.S. Equal Employment Opportunity Commission (EEOC), giving eligible employees a choice between remaining on employer-provided group health insurance or receiving employer-provided payment of Medicare Part B premiums generally would not constitute an impermissible adverse action against older workers under the Age Discrimination in Employment Act (ADEA) if it creates an advantageous option available only to them.

Whether a specific plan provides advantageous options, or imposes an adverse action, is dependent on the facts and circumstances. (Note: Under the specific facts addressed in the letter, employees were also required to provide written acknowledgement that they had reviewed both options and had voluntarily chosen to withdraw from employer-provided group health insurance.)

If the Medicare Part B reimbursement plan were to create an adverse action for older workers, it would be lawful only if it met an ADEA exemption or defense. A further discussion of exemptions and defenses is available in the letter. The letter is not a formal opinion and does not address Medicare or federal tax issues.


Individual Reporting Requirements 8-26-2015

Q. What happens if I did not file a 2014 federal tax return to reconcile my advance payment of the premium tax credit, or APTC. What do I need to do?
A. To keep their APTC and/or cost-sharing subsidy (CSR) for 2016, if you received APTC in 2014 you are required to file a 2014 federal tax return with Form 8962, Premium Tax Credit. If you don’t do this, you lose your subsidy and will have to pay the full cost of their monthly health insurance premiums for the 2016 plan year. Also, the IRS may contact you to pay back some or all of their 2014 APTC.

What you need to do if you received APTC in 2014:
• Electronically file your 2014 tax return with Form 8962 as soon as possible, even if you don’t normally have to file. To avoid a gap in APTC, you should file by the end of August.
• Use the Form 1095-A that you received from the Marketplace to complete Form 8962.
• If one nees a copy of Form 1095-A, they can log into their HealthCare.gov or state Marketplace account or call their Marketplace call center. (For FFM/HealthCare.gov number is 1-800-318-2596. For list of state marketplace contact numbers, see http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/The-Health-Insurance-Marketplace.)

Q. Where can I go if I need help filing their tax returns?
A. For more information on filing a 2014 tax return with Form 8962, you may visit IRS.gov/aca , call the IRS at 1-800-829-0922 or can contact your tax advisor.

Q. What happens if you received advance payments of the Premium Tax Credit in 2014 and don’t file a 2014 tax return or Form 8962?
A. You will not be eligible for advance payments of the premium tax credit (APTC) or cost-sharing reductions (CSRs) to help pay for their Marketplace health insurance coverage in 2016. This means you will be responsible for the full cost of the monthly premiums and all covered services. In addition, the IRS may contact you to pay back some or all of the APTC received for the 2014 plan year.

Q. How do I update and make changes to income, household or coverage to the Marketplace?
A. Keep in mind that once you  have Marketplace health insurance, federal rules require you to report changes to your income, household, address and health coverage eligibility to the Federal Marketplace as soon as possible. These updates may change the coverage or savings you are eligible for in the Marketplace. To update your income, family and other information, go to https://www.healthcare.gov/reporting-changes or call the Federal Marketplace 1-800-318-2596

New IRS reporting requirements for Applicable Large Employers (ALE) under the Affordable Care Act (ACA) 6.22.15

If you are an “Applicable Large Employer” with over 50 full time employees (including full time equivalents) you will be required to complete certain new IRS forms in early 2016 to be distributed to each employee by January 31st and submitted to the IRS by February 29, 2016, or March 31, 2016, if filing electronically.

Form 1095-C must be distributed to each employee and 1094C is submitted to the IRS. The IRS released drafts of the two required forms on June 16th so you have an idea of what will be required.

Here is the IRS link for instructions: http://www.irs.gov/instructions/i109495c/ar01.html#d0e221

See below for a couple of excepts from the IRS instruction guide:

Purpose of Form

Employers with 50 or more full-time employees (including full-time equivalent employees) use Forms 1094-C and 1095-C to report the information required under sections 6055 and 6056 about offers of health coverage and enrollment in health coverage for their employees. Form 1094-C must be used to report to the IRS summary information for each employer and to transmit Forms 1095-C to the IRS. Form 1095-C is used to report information about each employee. In addition, Forms 1094-C and 1095-C are used in determining whether an employer owes a payment under the employer shared responsibility provisions under section 4980H. Form 1095-C is also used in determining the eligibility of employees for the premium tax credit. Employers that offer employer-sponsored self-insured coverage also use Form 1095-C to report information to the IRS and to employees about individuals who have minimum essential coverage under the employer plan and therefore are not liable for the individual shared responsibility payment for the months that they are covered under the plan.

Who Must File

An employer subject to the employer shared responsibility provisions under section 4980H must file one or more Forms 1094-C (including a Form 1094-C designated as the Authoritative Transmittal, whether or not filing multiple Forms 1094-C), and must file a Form 1095-C (or a substitute form) for each employee who was a full-time employee of the employer for any month of the calendar year. Generally, the employer is required to furnish a copy of the Form 1095-C to the employee.

Hope this info helps you prepare for this new IRS requirement under the Affordable Care Act.

Update on Newest Change for Business Group Renewals 7.7.14

After more than four years of working on Healthcare Reform, one might expect the chaos to have settled down a bit. Unfortunately, the ambiguities of ACA (Affordable Care Act) and the Obama Administration’s shifting deadlines have extended and exacerbated the upheaval.

Some of this upheaval has resulted in good news for many of you. One of the shifting deadlines allowed you to keep your current pre-ACA group health insurance plan through 2014 and gave us all a chance to “let the dust settle” a little before being forced into the new ACA plans. (If you remember, everyone was going to have to go onto the new plans at renewal in 2014.)

Now, the newest shift in deadlines has just occurred and will allow many groups to keep your same current pre-ACA plan for yet another year ~ until your 2015 renewal!

Of course, upon receiving your upcoming renewal we will check your renewal against the new ACA plans to see what will be best and then make recommendations to you based upon the results.

I just wanted to give you a head’s up on what will be coming your way on this upcoming renewal so you will know ahead of time what to expect.

Thank you for letting Pope Insurance service your employee benefits plans. As always, it is our pleasure to take care of you and your employees.

Health Care Reform Update for Employers 6.3.14

One time Opportunity for Current Federal COBRA Enrollees to Move to New ACA Plan

The Department of Health and Human Services has provided a one-time-only Special Enrollment Period available until July 1, 2014, for individuals currently enrolled in a COBRA plan. This allows COBRA enrollees to move to a consumer market ACA plan and drop their COBRA coverage.

If you have any Florida employees who might benefit from this, have them contact me for help. This is a very small window of opportunity and may save them quite a bit of premium. If they are eligible for a subsidy, I will be able to help them with that, also.

Health Care Reform Update for Employers 5.27.14

Important News You Can Use:

On May 16, 2014, the Internal Revenue Service (IRS) issued a FAQ clarifying that it is illegal for an employer to pay for individual health coverage for employees inside or outside of the Marketplace with pre-tax dollars despite those who claim there are loopholes available that make such offerings permissible.

The IRS FAQ specifically clarifies that an employer who offers such an arrangement will be subject to an excise tax of $100 per day or $36,500 per year per employee.

A webinar last week by the law firm of Alston & Bird, LLT, put on at the request of our national professional association NAHU, scared me enough that I want to let all of you know that even if an employer raises the taxable wages of an employee to cover the cost of an individual plan with after tax dollars, the employer should not implicitly or explicitly indicate that the wage increase is attached to the health plan in any way, shape, or form. IRS is very serious about this.

So, please be aware of communications you may receive indicating you can avoid providing group coverage and save premium costs by sending your employees to purchase an individual plan and pay for their premiums on a pre-tax arrangement: health reimbursement account, medical reimbursement account, or some such thing. IRS is very explicit that this not allowed, and the fines are quite hefty.

~ Carolyn

For detailed information see: IRS Notice 2013-54 and the IRS May 16th FAQ. DOL has issued a notice in substantially identical form to Notice 2013-54, DOL Technical Release 2013-0, and HHS will shortly issue guidance to reflect that it concurs with Notice 2013-54. On Jan. 24, 2013, DOL and HHS issued FAQs that addressed the application of the Affordable Care Act to HRAs.

Health Care Reform Update 2.7.14

You are still required by law to have insurance this year.

You can only purchase ACA compliant health plans until March 31.

You do NOT have to go through the Federal Marketplace to purchase health insurance.

Read More:

Well, what a rocky start to our new health care system thus far!!
The marketplace website did not work properly; the employer mandate has been postponed for one year; some small groups will be allowed to keep their plans for another year and some will not….and, today there is discussion of postponing the individual mandate for THREE years!!! In addition, because the back end of the Marketplace, which processes premiums and subsidies, is still in the process of being built, some clients we enrolled in the Federal Marketplace in January are having difficulty paying their premiums! I could go on... but, I won’t!

These many problems yield great public confusion. The public is extremely confused about the law and how it is actually being implemented.

What should you do with this confusion? First, call us ~ we will be happy to advise you. And, here is some info for you to use: If you work and have group insurance provided through your employer, you can most likely rely on your employer to keep your plan compliant. If you purchase your own insurance, the current law is still in place and you are required to have a compliant Affordable Care Act plan with the 10 minimum essential benefits this year. So, as of today, you are still required by law to have insurance this year.

You can only purchase ACA compliant health plans until March 31st. Otherwise, you must wait until next open enrollment (October to December) to purchase a plan for January 1, 2015 unless you have a qualifying event or special exception during the year. The penalty for not having insurance this year is $95 per adult; half for each child; or, 1 % of your income ~ whichever is greater.

You do NOT have to go through the Federal Marketplace to purchase health insurance. You may go directly to the insurance company as you always have done. The Marketplace is for those who qualify for a subsidy. I am certified to help you both on and off of the marketplace.

Call us for help with your questions. This is all very confusing and we are daily helping people find the best value for the premium dollar ~~~ Carolyn

Health Care Reform Update 8.12.13

By now, we all know that most everyone must comply with the new PPACA law beginning January 1, 2014. Although the tax penalties have been delayed until January 1, 2015 for groups with 50+ employees, these large groups are still expected to comply with the law in 2014.


If you have a Grandfathered Plan, a plan purchased prior to March 23, 2010, and you have made very minor or no changes to it, you may keep your plan as it is and it will not be subject to many of the requirements under the new law.

If your plan began after March 23, 2010, you must comply with, and are subject to, the new requirements under the PPACA law on your renewal date in 2014 beginning with January renewals. You must purchase a PPACA compliant plan or be penalized.


By October 1, 2013, you will be required to distribute a notice to your employees called New Health Insurance Marketplace Coverage Options and Your Health Coverage. This notice must be given to all of your employees (including part time). The purpose of this notice is to let all of your employees know about the Federally Facilitated Exchange, called "The Health Insurance Marketplace".

Health Care Reform Update 8.12.13 ~~ from Carolyn L. Pope

Health Care Reform Update 6.21.13

The new Federal Exchange Marketplace, which will be operating in Florida effective January 1, 2014, is still on target to open for business 10.1.13 for effective dates of 1.1.14. The open enrollment period this first year will be from October 1, 2013 to March 31, 2014. Thereafter, it will be from October 1st to December 7th of each year for an effective date of January 1st.

Remember, groups with less than 50 full time equivalent employees are NOT subject to the tax penalties associated with larger (50+) employer groups. And, although there are many required group insurance changes for you and your employees, most of those changes whether you are a large or small group, will not take place until your 2014 renewal.

Due to the great confusion surrounding how the exchanges will actually work, some insurance carriers will be offering groups who renew the first six months of next year (2014) an opportunity to renew early at the end of this year (2013). This will carry you through for almost 12 months, and into 2014 before the law would really affect you. This will give time for the proverbial dust to settle.

Lots more to come! Rules are still being written and open for public comment. We just had a 253 page set of rules on the Exchanges published in the Federal Registry on Tuesday and open to public comment for 30 days.

I am still steadily attending seminars, webinars, reading professional journals, taking professional courses and certifications and am ready for what is to come for all size groups!

Health Care Reform Update 6.21.13 ~~ from Carolyn L Pope

Health Care Reform Update 4.2.13

By now you are beginning to hear a lot more about the new Health Care Reform changes and the Federal Exchange Marketplace effective this coming January, 2014.

What should I do? Since the required group insurance changes will not take place until your 2014 renewal date you can relax for now. As a small group (defined as under 50 employees) the actions required by you in order to comply will be minimal, and, you do not have much to be concerned about right this minute. Be assured, I will help you with comply with the new law.

What are the penalties? Please understand that only groups with 50+ employees are subject to "Pay or Play" along with tax penalties (non-deductible) and the more stringent compliance issues. This is more good news for our small employers.

A couple of mandatory changes coming with your 2014 renewal:

  • Waiting periods for new employees can be no longer than 90 days.
  • Only employees working 30+ hours weekly will be eligible. (Up from 25 hours now)

Although the Federal Exchange will be available for small group insurance January 1, 2014, we will be able to continue current group coverage outside of the exchange. I will prepare and review both scenarios to find your best option once the information is available so you will be knowledgeable to make the best decision for you and your employees.

New H.S.A and F.S.A Changes under Health Care Reform

You need to know:

Beginning in 2011, HSAs and FSAs may no longer be used to purchase over-the-counter (OTC) medications, such as non-prescription pain relievers, cold medicines, antacids and allergy medications. Over-the-counter medications prescribed by a physician will still be reimbursable on a tax-favored basis by these plans.

This new rule does not apply to reimbursements for the cost of insulin, which will continue to be permitted, even if purchased without a prescription.

Increased Tax Penalty for HSA for non-qualified usage:

If you use your tax-qualified account to purchase OTC medicines or other drugs purchased without a prescription after 1/1/11, or for other nonqualified withdrawals, those nonqualified expenses will be includable in your gross income and subject to an additional tax of 20%. This penalty increased from 10% to 20%.

Health Care Reform Update 4.2.13 ~~ from Carolyn L Pope

For Group Insurance Plans

This is a brief description of changes effective 9/23/10. Most of these changes will occur with your next renewal:

  1. Preventive benefits with no cost sharing. This means preventive benefits will be covered at 100% with no deductible or co-pay. If your plan is grandfathered, which means it is exactly the same plan as before Health Care Reform was enacted on March 23, 2010, the new preventive benefit provisions will not apply until 2014.
  2. Plan Maximums for Essential Benefits will be Unlimited. However, Essential Benefits are yet to be determined.
  3. Dependents may now be covered up to Age 26 even if not full-time students or if they are married. Of course, in Florida we cover to Age 30 and we are still waiting to see how the various insurance companies handle the requirements for dependents between Age 26 and Age 30. Most insurance companies enacted this benefit early in June of this year.
  4. Children under age 19 will be covered for pre-existing health conditions. Again, this is not new for us in Florida.

NEW - Small Business Tax Credit - Do You Qualify?

In general, the credit is available to small employers paying at least half the cost of single coverage for their employees.

- How to Qualify? Generally, the tax credit is available to employers with fewer than 25 full-time equivalent (FTE) employees paying wages averaging less than $50,000 per employee per year.

However, since the eligibility formula is based in part on the number of FTEs, not the number of employees, many businesses will qualify even if they employ more than 25 individual workers.

- How much is the Credit? The maximum credit is 35 percent of premiums paid in 2010 by eligible small business employers and 25 percent of premiums paid by eligible employers that are tax-exempt organizations. In 2014, this maximum credit increases to 50 percent of premiums paid by eligible small business employers and 35 percent of premiums paid by eligible employers that are tax-exempt organizations.

Do you qualify for the Maximum Credit? The maximum credit goes to smaller employers - those with 10 or fewer FTEs - paying annual average wages of $25,000 or less. How to claim the credit: Eligible small businesses can claim the credit as part of the general business credit starting with the 2010 income tax return they file in 2011. For tax-exempt employers, the IRS will provide further information on how to claim the credit. Your CPA will guide you in claiming your tax credit.

Link for More Information on Frequently Asked Questions:
Small Business Health Care Tax Credit: Frequently Asked Questions can be found at: http://www.irs.gov/newsroom/article/0,,id=220839,00.html


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