WHAT'S NEW IN INSURANCE (Archives)
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.
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.
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.
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.
NAHU Fast Facts – 05-03-2019
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
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.
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:
Which Members Must Be Provided the SPD:
When is the SPD Due:
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:
SEC. 11081. ELIMINATION OF SHARED RESPONSIBILITY PAYMENT FOR
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.
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
-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:
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
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.
Premium Tax Credits, Cost-Sharing Tax Credits, and Tax Credits to Territories
Small Business Tax Credit
Repeal of the Individual Mandate Penalty
Repeal of Employer Mandate Penalty
Repeal of Health Insurance Tax
Repeal Excise/Cadillac Tax
Repeal of Medical Loss Ratio Requirement
-National Association of Health Underwriters-
Preparing for ACA’s Employer Reporting in 2017 - 11-14-2016
Posted on November 14, 2016 by nahucompliance
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:
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.
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.
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:
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?
Employer Medicare Reimbursements 9-30-2015
Can I reimburse my employees for their Medicare Premiums?
Medicare Premium Reimbursement Arrangements for Employers
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.
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.
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?
Q. Where can I go if I need help filing their tax returns?
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?
Q. How do I update and make changes to income, household or coverage to the Marketplace?
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:
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.
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.
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.
WHAT TO EXPECT FOR INDIVIDUALS AND GROUPS:
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.
IMPORTANT NEW FEDERAL REQUIREMENT FOR EMPLOYERS:
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:
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:
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: