SBC Template, and Required Addendums for Covered Entities under ACA Section 1557

Make sure to stay updated with all the recent rules and regulation regarding the ACA, thanks to our partners at United Benefits Advisor (UBA).

A Summary of Benefits and Coverage (SBC) is four page (double-sided) communication required by the federal government. It must contain specific information, in a specific order, and with a minimum size type, about a group health benefit’s coverage and limitations. If an employer providing an SBC is a covered entity under the ACA’s Section 1557, additional requirements apply.

On April 6, 2016, the Centers for Medicare and Medicaid Services (CMS), the Department of Labor (DOL), and the Department of the Treasury issued the final 2017 summary of benefits and coverage (SBC) template, group and individual market SBC instructions, uniform glossary of coverage and medical terms, a coverage example calculator, and calculator instructions.

The SBC is to be used by all health plans, including individual, small group, and large group; insured and self-insured; grandfathered, transitional, and ACA compliant. The new SBC must be used for plan years with open enrollment periods beginning after April 1, 2017. It will not be used for marketplace plans for the 2017 coverage year.

For fully insured plans, the insurer is responsible for providing the SBC to the plan administrator (usually this is the employer). The plan administrator and the insurer are both responsible for providing the SBC to participants, although only one of them actually has to do this.

For self-funded plans, the plan administrator is responsible for providing the SBC to participants. Assistance may be available from the plan administrator’s TPA, advisor, etc., but the plan administrator is ultimately responsible. (The plan administrator is generally the employer, not the claims administrator.)

Changes

The template includes a new “important question” that asks “Are there services covered before you meet your deductible?” and requires family plans to disclose whether or not the plan has embedded deductibles or out-of-pocket limits. This is reported in the “Why This Matters” column in relation to the question “what is the overall deductible?” and plans must list “If you have other family members on the policy, they have to meet their own individual deductible until the overall family deductible has been met” or alternatively, “If you have other family members on the policy, the overall family deductible must be met before the plan begins to pay.”

Tiered networks must be disclosed and the question “Will you pay less if you use a network provider?” is now included. The SBC also includes language that warns participants that they could receive out-ofnetwork providers while they are in an in-network facility. The SBC also indicates that a consumer could receive a “balance bill” from an out-of-network provider.

The “explanatory coverage page” was dropped from the template.

The coverage examples provided clarify the “having a baby” example and the “managing type 2 diabetes” example, in addition to providing a third example of “dealing with a simple fracture.” The coverage example must be calculated assuming that a participant does not earn wellness credits or participate in an employer’s wellness program. If the employer has a wellness program that could reduce the employee’s costs, the employer must include the following language: “These numbers assume the patient does not participate in the plan’s wellness program. If you participate in the plan’s wellness program, you may be able to reduce your costs. For more information about the wellness program, please contact: [insert].”

The column for “Limitations, Exceptions, & Other Important Information” must contain core limitations, which include:

  • When a service category or a substantial portion of a service category is excluded from coverage (that is, the column should indicate “brand name drugs excluded” in health benefit plans that only cover generic drugs);
  • When cost sharing for covered in-network services does not count toward the out-of-pocket limit;
  • Limits on the number of visits or on specific dollar amounts payable under the health benefit plan; and  When prior authorization is required for services.
  • When prior authorization is required for services.

The template and instructions indicate that qualified health plans (those certified and sold on the Marketplace) that cover excepted abortions (such as those in cases of rape or incest, or when a mother’s life is at stake) and plans that cover non-excepted abortion services must list “abortion” in the covered services box. Plans that exclude abortion must list it in the “excluded services” box, and plans that cover only excepted abortions must list in the “excluded services” box as “abortion (except in cases of rape, incest, or when the life of the mother is endangered).” Health plans that are not qualified health plans are not required to disclose abortion coverage, but they may do so if they wish

Impact of Section 1557 of the ACA – Addendum Required for Covered Entities

On May 13, 2016, the Department of Health and Human Services (HHS) issued a final rule implementing Section 1557 of the Patient Protection and Affordable Care Act (ACA), which took effect on July 18, 2016. Under these regulations, covered entities must provide notices stating they do not discriminate on certain grounds in “significant public-facing publications.” HHS has gone on to confirm that an SBC is a significant public-facing publication.

ACA Section 1557 provides that individuals shall not be excluded from participation, denied the benefits of, or be subjected to discrimination under any health program or activity which receives federal financial assistance from HHS on the basis of race, color, national origin, sex, age, or disability. The rule applies to any program administered by HHS or any health program or activity administered by an entity established under Title I of the ACA. These applicable entities are “covered entities” and include a broad array of providers, employers, and facilities. State-based Marketplaces are also covered entities, as are FederallyFacilitated Marketplaces.

The final regulations are aimed primarily at preventing discrimination by health care providers and insurers, as well as employee benefits programs of an employer that is principally or primarily engaged in providing or administering health services or health insurance coverage, or employers who receive federal financial assistance to fund their employee health benefit program or health services. Employee benefits programs include fully insured and self-funded plans, employer-provided or sponsored wellness programs, employer provided health clinics, and longer-term care coverage provided or administered by an employer, group health plan, third party administrator, or health insurer

Practically speaking, employers with fully insured group health plans will be subject to the regulations (because the carrier is a covered entity and is prohibited from selling discriminatory plans), and many self funded employers will be considered a covered entity based on their business model or financial details. Furthermore, most third party administrators (TPAs) will be considered a covered entity. The Office of Civil Rights (OCR) will investigate a TPA when there is alleged discrimination in the administration of the plan. However, if the alleged discrimination is in benefit plan design (that is, the choice of the employer), the OCR will process the complaint against the employer or plan sponsor. If the OCR lacks jurisdiction over the employer, it will refer the matter to the Equal Employment Opportunity Commission (EEOC). This means that employers who are not covered entities, but have a self-funded group health plan that utilizes a TPA that is a covered entity, could become the subject of an EEOC investigation for discriminatory business practices.

Employers with self-funded group health plans should seek legal counsel to determine if they are a covered entity, and to obtain legal advice on the applicability of these regulations to their individual situation.

Covered entities must take steps to notify beneficiaries, enrollees, applicants, or members of the public of their nondiscrimination obligations with respect to their health programs and activities. Covered entities are required to post notices stating that they do not discriminate on the grounds prohibited by Section 1557, and that they will provide free (and timely) aids and services to individuals with limited English proficiency and disabilities. These notices must be posted in conspicuous physical locations where the entity interacts with the public, in its significant public-facing publications, and on its website home page. In addition, covered entities that employ 15 or more persons must designate a responsible employee to coordinate the entity’s compliance with the rule and adopt a grievance procedure. Employers who are covered entities should seek advice of counsel on the ways these requirements apply to them and their group health plan, and employers who are not covered entities but have a fully insured group health plan should discuss how the insurance carrier will meet these requirements.

The OCR has provided a model notice and model statement of nondiscrimination, and taglines for employers to use. The OCR has also created an FAQ and table relating to the top 15 languages spoken in each state.

HHS has stated that an SBC is a publication that is “significant” under the Section 1557 regulations. As a result, CMS requires the use of an addendum to the SBC to accommodate applicable language access standards. Accordingly, covered entities required to provide an SBC must include the nondiscrimination notice and taglines in its addendum along with other applicable language access standards. This addendum must contain only the Section 1557 nondiscrimination notice and taglines and other applicable language access information.

To download the full compliance alert click Here.


Health Law’s 10 Essential Benefits: A Look At What’s At Risk In GOP Overhaul

Great article from Kaiser Health News about all the changes that could be coming with the ACA overhaul by Michelle Andrews

As Republicans look at ways to replace or repair the health law, many suggest shrinking the list of services insurers are required to offer in individual and small group plans would reduce costs and increase flexibility. That option came to the forefront last week when Seema Verma, who is slated to run the Centers for Medicare & Medicaid Services in the Trump administration, noted at her confirmation hearing that coverage for maternity services should be optional in those health plans.

Maternity coverage is a popular target and one often mentioned by health law critics, but other items also could be watered down or eliminated.

There are some big hurdles, however. The health law requires that insurers who sell policies for individuals and small businesses cover at a minimum 10 “essential health benefits,” including hospitalization, prescription drugs and emergency care, in addition to maternity services. The law also requires that the scope of the services offered be equal to those typically provided in employer coverage.

“It has to look like a typical employer plan, and those are still pretty generous,” said Timothy Jost, an emeritus professor at Washington and Lee University Law School in Virginia who is an expert on the health law.

Since the 10 required benefits are spelled out in the Affordable Care Act, it would require a change in the law to eliminate entire categories or to water them down to such an extent that they’re less generous than typical employer coverage. And since Republicans likely cannot garner 60 votes in the Senate, they will be limited in changes that they can make to the ACA. Still, policy experts say there’s room to “skinny up” the requirements in some areas by changing the regulations that federal officials wrote to implement the law.

Habilitative Services

The law requires that plans cover “rehabilitative and habilitative services and devices.” Many employer plans don’t include habilitative services, which help people with developmental disabilities such as cerebral palsy or autism maintain, learn or improve their functional skills. Federal officials issued a regulation that defined habilitative services and directed plans to set separate limits for the number of covered visits for rehabilitative and habilitative services.

Those rules could be changed. “There is real room for weakening the requirements” for habilitative services, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who has reviewed the essential health benefits coverage requirements.

Oral And Vision Care For Kids

Pediatric oral and vision care requirements, another essential health benefit that’s not particularly common in employer plans, could also be weakened, said Caroline Pearson, a senior vice president at Avalere Health, a consulting firm.

Mental Health And Substance Use Disorder Services

The health law requires all individual and small group plans cover mental health and substance use disorder services. In the regulations the administration said that means those services have to be provided at “parity” with medical and surgical services, meaning plans can’t be more restrictive with one type of coverage than the other regarding cost sharing, treatment and care management.

“They could back off of parity,” Palanker said.

Prescription Drugs

Prescription drug coverage could be tinkered with as well. The rules currently require that plans cover at least one drug in every drug class, a standard that isn’t particularly robust to start with, said Katie Keith, a health policy consultant and adjunct professor at Georgetown Law School. That standard could be relaxed further, she said, and the list of required covered drugs could shrink.

Preventive And Wellness Services And Chronic Disease Management

Republicans have discussed trimming or eliminating some of the preventive services that are required to be offered without cost sharing. Among those requirements is providing birth control without charging women anything out of pocket. But, Palanker said, “if they just wanted to omit them, I expect that would end up in court.”

Pregnancy, Maternity And Newborn Care

Before the health law passed, just 12 percent of health policies available to a 30-year-old woman on the individual market offered maternity benefits, according to research by the National Women’s Law Center. Those that did often charged extra for the coverage and required a waiting period of a year or more. The essential health benefits package plugged that hole very cleanly, said Adam Sonfield, a senior policy manager at the Guttmacher Institute, a reproductive health research and advocacy organization.

“Having it in the law makes it more difficult to either exclude it entirely or charge an arm and a leg for it,” Sonfield said.

Maternity coverage is often offered as an example of a benefit that should be optional, as Verma advocated. If you’re a man or too old to get pregnant, why should you have to pay for that coverage?

That a la carte approach is not the way insurance should work, some experts argue. Women don’t need prostate cancer screening, they counter, but they pay for the coverage anyway.

“We buy insurance for uncertainty, and to spread the costs of care across a broad population so that when something comes up that person has adequate coverage to meet their needs,” said Linda Blumberg, a senior fellow at the Health Policy Center at the Urban Institute.

See the original article Here.

Source:

Andrews M. (2017 February 21). Health law’s 10 essential benefits: a look at what’s at risk in GOP overhaul [Web blog post]. Retrieved from address http://khn.org/news/health-laws-10-essential-benefits-a-look-at-whats-at-risk-in-gop-overhaul/


Employees desperately need more information on health plans, study says

Did you know that a lot of your employees may be unaware of the health care options your company offers? Take a peek at this great article from HR Morning on how to improve your employees knowledge of their healthcare options by Jared Bilski

As an increasing number of employees are being asked to make smarter healthcare spending decisions, communication is more important than ever. Unfortunately, it looks like many firms have a lot of room for improvement.  

That’s one of the alarming takeaways from healthcare administrator Alegeus’ recent “State of Denial” study.

A number of the stats from the study point to a major employee healthcare problem that’s only getting worse. That problem: While employees’ health options are becoming increasingly complex, most workers don’t have the knowledge and/or accountability to make wise decisions involving those options.

Unaware and overwhelmed

Here are some of the most alarming stats from the study:

  • 63% of employees said they don’t know the benefit of an HSA
  • 50% don’t know how to predict current or future out-of-pocket healthcare expenditures and can’t select the best savings vehicle or rate
  • 26% of HSA accountholders don’t know they can use HSA funds beyond the immediate plan year, and
  • 41% of HSA accountholders were unaware they could invest HSA funds.

The study also highlighted some of the contradictions between what employees said they wanted or needed, and how they acted.

For example, although 70% of employees said they’d like to take a more active role in their healthcare decisions, just 50% intend to conduct more due diligence when purchasing healthcare in 2017.

The importance of one on one

One of the most effective ways to improve employees’ benefits understanding is through one-on-one communications.

To help ensure this is effective, here are three things HR pros should keep in mind, according to Winston Benefits, a voluntary benefits plan provider:

1. Prepare the right materials

When you’re doing a large-scale benefits presentation, you generally just hand out the materials, and employees look through and use those materials as they see fit.

But with individual sessions, benefits pros have to be prepared to explain those materials in any way an employee requests.

Example: Walking a worker through a tool or calculator in a step-by-step manner.

2. Look to your broker

In many cases, benefits brokers are willing to go on site for one-on-one sessions, and companies should take advantage whenever possible.

Employees will be comfortable knowing there’s an in-house HR or benefits pro at the broker, and a broker’s expertise can really improve workers’ overall understanding.

3. Allot enough time

The point of these meetings is to give employees all the time they need to understand their options and make informed decisions.

Rushing workers through these meetings will ensure the one-on-one education falls flat.

See the original article Here.

Source:

Bilski J. (2017 February 17). Employees desperately need more information on health plans, study says [Web blog post]. Retrieved from address http://www.hrmorning.com/employees-desperately-need-more-information-on-health-plans-study-says/


Where exactly are we in the ACA repeal process?

Worried about the ACA repeal process? Check out this informative article from HR Morning about the status of the ACA’s repeal by Christian Schappel,

President Trump, along with other Republican lawmakers, have promised to “repeal and replace” the Affordable Care Act (ACA). But it hasn’t happened yet. Here’s why, as well as a timeline for what’s to come. 

In his “Contract with the American Voter,” Donald Trump promised to repeal Obamacare within his first 100 days in office. But the reality is he can’t do it on his own. He needs votes to get it repealed outright — and he doesn’t have enough of them.

What’s the hold up?

Broad legislation that would repeal the ACA would require 60 votes in the Senate, and the GOP doesn’t control enough seats to make that a reality — or avoid a filibuster by the Democrats.

Still, that hasn’t stopped Trump from declaring war on the healthcare reform law. In one of his first acts as president, Trump issued an executive order that directs federal agencies to waive some of the requirements of the law that could impose a burden on individuals and certain businesses.

It was a clear sign from Trump that his administration plans to attack the ACA by any means necessary.

So what’s the plan now?

Congressional Republicans are now preparing to dismantle portions of the ACA using a process known as reconciliation. It will allow the GOP to vote on budgetary pieces of the health law, without giving the Democrats a chance to filibuster.

The problem for Republicans is reconciliation limits the extent to which they can reshape the law.

Parts of the law it appears they can roll back through reconciliation:

  • The individual mandate (which is imposed through a tax)
  • The employer mandate (which imposed through a tax), and
  • The subsidies to help individuals purchase coverage (which require government funding).

The Republicans believe that through reconciliation they can knock the legs out from under the ACA and begin to implement their own health reforms.

Some of the things members of the GOP have indicated they want to do:

  • Go to a more free-market approach, in which individuals would have greater ability to purchase health insurance across state lines
  • Expand health savings accounts
  • Allow individuals to deduct the cost of health insurance premiums from their income taxes, and
  • Let states manage Medicaid funds.

Two popular ACA provisions Republicans said they plan to keep in health plans:

  • The prohibition on denying coverage to those with pre-existing conditions, and
  • The ability for children to stay on their parents’ plans until age 26.

So when is it all going to happen?

When it comes to a timeline for when the GOP hopes to initiate reforms, things are a little murky. The problem is, due to the reconciliation process — and complaints from insurers about what the requirement to provide coverage to those with pre-existing conditions will do to risk pools and pricing — things aren’t as cut and dried as employers would like them to be.

But here’s what we know:

  • In late January, at its annual retreat, the GOP said it wants to bring a final reconciliation package to the floor of the House by late February or early March
  • In a pre-Super Bowl interview with Fox News’ Bill O’Reilly, President Trump said the repeal and replace process is “complicated” and could take until “sometime next year,” and
  • Just a few days after Trump’s statements to O’Reilly, House Speak Paul Ryan (R-WI) said the president’s remarks won’t alter the timeline for the House GOP to introduce significant repeal and replace legislation by the end of 2017. Still, Ryan did indicate that even if such legislation is passed, it could take some time for it to be fully implemented.

Bottom line: Employers are likely looking at a long legislative process, and an even longer implementation period.

Bills that could chip away at law

While Congress mulls larger-scale changes to the ACA, a few bills have been introduced for lawmakers to chew on.

The following could chip away at certain elements of reform:

  • The Middle Class Health Benefits Tax Repeal Act (H.R. 173) would kill the 40% deductible excise tax (a.k.a., “the Cadillac tax”) on high-cost employer health plans
  • The Health Savings Account Expansion Act (H.R. 247 and S. 28) would permit the reimbursement of health insurance premiums and increase the maximum allowable contribution, and
  • The Healthcare Tax Relief and Mandate Repeal Act (H.R. 285) would kill both the individual and the employer health insurance mandates.

See the original article Here.

Source:

Schappel C. (2017 February 10). Where exactly are we in the ACA repeal process? [Web blog post]. Retrieved from address http://www.hrmorning.com/where-are-we-aca-obamacare-repeal-trump/


How Obama’s last healthcare legislation is further hurting the ACA’s chances of survival

Due to the most recent changes President Obama made to the ACA before leaving office, ACA repeal is looking more and more like a possibility. Take a look at this great article from Employee Benefits Advisors to see how the changes will affect the ACA repeal process by Craig Hasday

President Trump is delivering on what many had viewed as an unrealistic campaign promise: The repeal of Obamacare is right on track. In finalizing the budget, the GOP can now line out any ACA items with a fiscal impact, thanks to an executive order issued by Trump on his first day in office. By lining out the individual and employer penalty and eliminating some of the ACA taxes – voila – the ACA is gone.

The market reforms will stay, however (no pre-existing conditions, guaranteed issue coverage and dependents covered to age 26). But there is an enormous “if.” If the insurance carriers stay in the market.

One of the reasons the ACA is not working is the adverse selection issue. Insurance carriers must take all comers, and since the individual penalty for not obtaining coverage is full of loopholes, and not large enough to dissuade the young and healthy from rolling the dice, the risk pool has performed horrifically. That should be no surprise – I have been writing about it for years; a few examples here, here, here and here.

But if the individual penalty is repealed, it is going to get even worse. The healthy are going to leave and the risk pools will be left with a lot of expensive sick people who love the idea of guaranteed coverage, premiums and unlimited maximums.

The problem with QSEHRAs
The prior Congress and former President Obama didn’t help matters with the passage of the 21st Century Cures Act, which was signed into law in December 2016. This law allows small employers who don’t offer a group health plan to create a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). Employers can provide money to employees on a tax-free basis to pay for individual health insurance policies and to reimburse employees for certain medical expenses. This is going to make the small group pools worse and, my guess is, increase adverse selection even more.

Given the losses incurred to date and the additional selection being imposed on the healthcare system, the big question is will the health insurance carriers stay in the marketplace? If mainstream carriers refuse to offer policies – BOOM – the system implodes.

To quote the best show on Broadway, “Hamilton,” I would love “to be in the room where it happens.” This is going to be interesting to watch.

See the original article Here.

Source:

Hasday C. (2017 February 06). How Obama’s last healthcare legislation is further hurting the ACA’s chances of survival [Web blog post]. Retrieved from address http://www.employeebenefitadviser.com/opinion/how-obamas-last-healthcare-legislation-is-further-hurting-the-acas-chances-of-survival


USCIS Publishes Updated Guidance on Completing New I-9 Form

Stay up to date with the most recent HR rules and regulations thanks to our partners at United Benefits Advisor (UBA),

On January 22, 2017, it became mandatory for employers to use the revised version of Form I-9, the Employment Eligibility Verification Form. U.S. Citizenship and Immigration Services (USCIS) has published the updated M-274, Handbook for Employers: Guidance for Completing Form I-9, which offers detailed guidance for employers completing Form I-9.

This updated Handbook for Employers additionally:

  • Captures policy and regulatory changes since 2013
  • Is written in plain language, so that it is easier to understand
  • Includes a streamlined questions and answers section
  • Features updated tables, new figures, and more current sample documents
  • Explains guidance regarding automatic extensions for certain Employment Authorization Documents I-9s are required for all newly hired and re-hired employees.

I-9s are required for all newly hired and re-hired employees. Employers who violate the law are subject to civil fines, criminal penalties, and debarment from government contracts. Failing to comply with verification requirements carries penalties of up to $2,156 per form.

Changes and updates to Form I-9 include:

  • The ability to complete the I-9 electronically
  • Instructions on providing email addresses (new to the form)
  • Requirements when using a designee to complete the form
  • Examples of how to use the “Additional Information” section
  • Instructions on updating forms when receipts were used as an original document
  • An extensive new section on Automatic Extensions of Employment (EAD)
  • Use of Native American Tribal documents
  • Employer responsibilities when providing practical training to STEM OPT students
  • Rules on reverification
  • How to correct errors

In addition to the Handbook for Employers, the Table of Changes for Revised M-274 is a quick reference table that highlights all changes to the new form and verification process

To download the full HR recap click Here.


Implications of the 21st Century Cures Act

Great article from our partner, United Benefit Advisors (UBA) about the impact of the 21st Century Cures Act by Danielle Capilla,

On December 13, 2016, former President Obama signed the 21st Century Cures Act into law. The Cures Act has numerous components, but employers should be aware of the impact the Act will have on the Mental Health Parity and Addiction Equity Act, as well as provisions that will impact how small employers can use health reimbursement arrangements (HRAs). There will also be new guidance for permitted uses and disclosures of protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA). We review the implications with HRAs below; for a discussion of all the implications, view UBA’s Compliance Advisor, “21st Century Cares Act”.

The Cures Act provides a method for certain small employers to reimburse individual health coverage premiums up to a dollar limit through HRAs called “Qualified Small Employer Health Reimbursement Arrangements” (QSE HRAs). This provision will go into effect on January 1, 2017.

Previously, the Internal Revenue Service (IRS) issued Notice 2015-17 addressing employer payment or reimbursement of individual premiums in light of the requirements of the Patient Protection and Affordable Care Act (ACA). For many years, employers had been permitted to reimburse premiums paid for individual coverage on a tax-favored basis, and many smaller employers adopted this type of an arrangement instead of sponsoring a group health plan. However, these “employer payment plans” are often unable to meet all of the ACA requirements that took effect in 2014, and in a series of Notices and frequently asked questions (FAQs) the IRS made it clear that an employer may not either directly pay premiums for individual policies or reimburse employees for individual premiums on either an after-tax or pre-tax basis. This was the case whether payment or reimbursement is done through an HRA, a Section 125 plan, a Section 105 plan, or another mechanism.

The Cures Act now allows employers with less than 50 full-time employees (under ACA counting methods) who do not offer group health plans to use QSE HRAs that are fully employer funded to reimburse employees for the purchase of individual health care, so long as the reimbursement does not exceed $4,950 annually for single coverage, and $10,000 annually for family coverage. The amount is prorated by month for individuals who are not covered by the arrangement for the entire year. Practically speaking, the monthly limit for single coverage reimbursement is $412, and the monthly limit for family coverage reimbursement is $833. The limits will be updated annually.

Impact on Subsidy Eligibility. For any month an individual is covered by a QSE HRA/individual policy arrangement, their subsidy eligibility would be reduced by the dollar amount provided for the month through the QSE HRA if the QSE HRA provides “unaffordable” coverage under ACA standards. If the QSE HRA provides affordable coverage, individuals would lose subsidy eligibility entirely. Caution should be taken to fully education employees on this impact.

COBRA and ERISA Implications. QSE HRAs are not subject to COBRA or ERISA.

Annual Notice Requirement. The new QSE HRA benefit has an annual notice requirement for employers who wish to implement it. Written notice must be provided to eligible employees no later than 90 days prior to the beginning of the benefit year that contains the following:

  • The dollar figure the individual is eligible to receive through the QSE HRA
  • A statement that the eligible employee should provide information about the QSE HRA to the Marketplace or Exchange if they have applied for an advance premium tax credit
  • A statement that employees who are not covered by minimum essential coverage (MEC) for any month may be subject to penalty

Recordkeeping, IRS Reporting. Because QSE HRAs can only provide reimbursement for documented healthcare expense, employers with QSE HRAs should have a method in place to obtain and retain receipts or confirmation for the premiums that are paid with the account. Employers sponsoring QSE HRAs would be subject to ACA related reporting with Form 1095-B as the sponsor of MEC. Money provided through a QSE HRA must be reported on an employee’s W-2 under the aggregate cost of employer-sponsored coverage. It is unclear if the existing safe harbor on reporting the aggregate cost of employer-sponsored coverage for employers with fewer than 250 W-2s would apply, as arguably many of the small employers eligible to offer QSE HRAs would have fewer than 250 W-2s.

Individual Premium Reimbursement, Generally. Outside of the exception for small employers using QSE HRAs for reimbursement of individual premiums, all of the prior prohibitions from IRS Notice 2015-17 remain. There is no method for an employer with 50 or more full time employees to reimburse individual premiums, or for small employers with a group health plan to reimburse individual premiums. There is no mechanism for employers of any size to allow employees to use pre-tax dollars to purchase individual premiums. Reimbursing individual premiums in a non-compliant manner will subject an employer to a penalty of $100 a day per individual they provide reimbursement to, with the potential for other penalties based on the mechanism of the non-compliant reimbursement.

See the original article Here.

Source:

Capilla D. (2017 February 01). Implications of the 21st century cures act [Web blog post]. Retrieved from address http://blog.ubabenefits.com/implications-of-the-21st-century-cures-act


9 questions employees have about ACA – and how to answer them

Have your employees been asking more questions about the ACA? Check out this great article from HR Morning about some of the question your employees might ask and how to answer them by Christian Schappel.

Even under the Trump administration, the Affordable Care Act (ACA) is still a real, enforceable law. You already know this. But do all of your employees? 

Chances are, once employees start getting their ACA-mandated 1095 forms from you in the next few weeks, some of them are going to have questions — à la: What is this? I thought Trump did away with Obamacare.

Here are some of the questions employees are asking — and are bound to ask — along with how HR can answer them:

1. Didn’t Trump repeal Obamacare?

No. While he has promised to “repeal and replace” the ACA, all he has done so far is sign an executive order that directs federal agencies to grant certain exemptions from the law, as well as waive any requirements that they’re able to by law.

Surely, the executive order will eventually weaken some parts of the ACA — and maybe even lead to some repeals — but nothing concrete has happened yet. As a result, employers still have to comply with the “play or pay” mandates, and individuals still have to carry health insurance or risk penalties.

2. Didn’t Republicans in Congress start repealing the law?

No. Republicans in Congress don’t have the votes they need to repeal the ACA outright. They can’t avoid a Democratic filibuster.

As a result, what they have done is state their intention to attack the law through a process known as reconciliation. It’ll allow Republicans to vote on budgetary pieces of the law — like the individual mandate (which is imposed with a tax) and healthcare subsidies — without giving the Democrats a chance to filibuster.

The problem for Republicans, though, is that reconciliation limits how they can reshape (or repeal) Obamacare.

3. Then when will Obamacare be repealed?

All you can tell employees right now is that it hasn’t happened, and there is no clear answer on when (or even if) it will happen in its entirety.

However, Republicans recently made two things clear at its recent annual retreat in Philadelphia:

  • They plans to use the reconciliation process to “repeal and replace” parts of the law.
  • The GOP will bring a final reconciliation package to the floor of the House of Representatives by late February or early March.

Chances are, we’ll find out more once Trump’s cabinet picks — specifically his pick to lead the Department of Health and Human Services — have been confirmed.

4. If I have a pre-existing condition, will I have trouble finding a health plan?

President Trump, as well as Republicans in Congress, have stated their intentions to attempt to keep two popular requirements of the ACA in place:

  • The need for insurance companies to offer coverage to individuals with pre-existing conditions.
  • The ability for children to be able to stay on their parents’ health plans until age 26.

Form 1095 questions

5. What is this form?

Form 1095 is a little like Form W-2: The employer or insurer sends one copy to the Internal Revenue Service (IRS) and one copy to the employee. It describes whether the person obtained the minimum required level of health insurance under the ACA in 2016.

It also informs the IRS, and the employee, if the person was eligible for a premium tax credit in 2016.

6. If Obamacare is going to be repealed, do I still need this form?

Yes. The reason is because the ACA was in effect for all of 2016, and this form is for reporting information that reflects what happened in 2016.

7. What do I have to do with it?

In most cases, no action will be necessary. When filing taxes for 2016, individuals will be asked if they obtained minimum insurance coverage. This form will help individuals answer that question.

8. Do I have to wait to receive the form to file my taxes?

Again, in most cases, the answer is no. Only those who received insurance via an exchange or the “marketplace” will have to wait for their 1095 to file their taxes.

If a person received insurance through an employer, that person doesn’t have to wait for Form 1095 to file his or her taxes, assuming the person already knows whether or not they had minimum coverage throughout the year. In that case, the person can just keep the form for their records.

If a person’s unsure whether he or she had minimum coverage for the entire year, that person can wait for the form to file their taxes or ask their employer whether he or she had minimum coverage.

9. How will I receive the form(s)?

Individuals may receive their form(s) in one of three ways:

  • mail
  • hand delivery, or
  • electronically (if they have consented to receive it electronically).

See the original article Here.

Source:

Schappel C. (2017 February 1). 9 questions employees have about ACA- and how to answer them [Web blog post]. Retrieved from address http://www.hrmorning.com/employee-questions-aca-obamacare-repeal-answers/


What Trump’s ACA executive order means for employers

Great article from our partner, United Benefit Advisors (UBA) by Nick Otto

President Donald Trump wasted no time in fulfilling one promise he made time and again on his campaign trail in undoing the Affordable Care Act on day one in office.

On Friday, Trump issued an executive order directing members of his administration to take steps that will facilitate the repeal and replacement of the ACA, but experts note employers should continue with business as usual until solid formalities come out.

From an employer’s perspective, “every regulation they need to comply with, they still need to until they hear differently,” says Steve Wojcik, vice president of public policy at the National Business Group on Health.

What Trump’s order did was send a signal to everyone that his administration is prioritizing to repeal major parts of the ACA and to replace it with something else.

“In terms of specifics, nothing changes now, and it makes it clear that some changes may take longer than others because of the regulatory process to revise existing regulations,” Wojcik notes.

This specific order reiterates that it is administration policy to seek the repeal and replacement of the ACA and directs relevant agencies like Health and Human Services, Treasury and Labor, to utilize their authorities under the act “to minimize the unwarranted economic and regulatory burdens of the Act, and prepare to afford the States more flexibility and control to create a more free and open healthcare market,” according to the order.

But the different agencies will have to follow the law that requires notice and commenting periods before any final regulation is put in place, adds Chatrane Birbal, a government relations senior advisor with the Society for Human Resource Management.

“Trump’s administration is drawing a line in the sand,” she says. “While Congress is working on making its changes on a legislative front, Trump wants to move forward with the regulatory side.”

The most immediate focus will be whether the IRS acts to delay the employer reporting requirements under the employer shared responsibility provisions of the law, points out Joy Napier-Joyce, principal and leader of the employee benefits group at labor & employment law firm Jackson Lewis P.C.

“Employer reporting is key to assessing employer penalties under the employer mandate, [but it] represents a significant burden to employers and the deadlines are fast approaching,” she says. Similarly, Napier-Joyce says, “we have not seen enforcement of employer penalties under the employer mandate to date.”

Especially given Trump’s announcement Monday of a hiring freeze for federal workers and the known shortage of resources at the IRS, employers will be eager to glean hints as to any non-enforcement stances, she says. Much of the requirements under the employer mandate have been formalized through statute and regulation, so in order to effectively and completely reverse course, formal processes will need to be followed, which will in turn take time.

“For now, employers should stay the course, but stay tuned as we await how and when the agencies, particularly the IRS, choose to exercise discretion,” Napier-Joyce adds.

One issue Birbal advises keeping an eye on is that the executive order calls for greater flexibility to states.

“This could be a concern for employers because it doesn’t recognize ERISA preemption,” she notes. “It has provided employers and employees with a workable regulatory framework for benefits, offering uniform set of benefits to employees throughout out the U.S.”

“We believe the flexibility and certainty of the ERISA framework already in place has been a success to the employers sponsored system and we hope that’ll be maintained,” she adds.

Another area to note, says NBGH’s Wojcik, is how providers could be impacted by the order.

“There are a lot of punitive delivery reform regulations that are in various stages of completion or haven’t been issued,” he says. “To the extent that that affects hospitals and physicians, it could be an area where you see a lot of impact besides issues like the individual mandates and excise tax.”

As for policies that were still in the works, “if something hasn’t come out yet, it’s likely that it won’t come out ever based on executive order,” Wojcik notes.

See the original article Here.

Source:

Otto N. (2017 January 23). What trump’s ACA executive order means for employers [Web blog post]. Retrieved from address http://www.benefitnews.com/news/what-trumps-aca-executive-order-means-for-employers?feed=00000152-18a4-d58e-ad5a-99fc032b0000


Why technology is not just a ‘thought but a necessity’

Are you utilizing your technology to its advantages? Check out this article from Employee Benefits Advisors about the importance of technology in today’s marketplace by Brian M. Kalish

More than half of all brokers nationwide are still using paper and have no online database of their clients — but the industry is about to reach a tipping point, where those still using old processes will be left behind.

According to a recent survey of 10,000 brokers by hCentive, 54% still use paper and 53% have no online database.

Having no online database is the most challenging part, Lisa Collins, director of business development at hCentive said a recent event for brokers sponsored by the company in Reston, Va. Those brokers, she said, lack a central place for their resources.

But for brokers still using these old processes, the industry is reaching a tipping point, she said, where “technology is not just a thought [but] a necessity.”

It will become necessary, she explained, because the industry is demanding technology solutions as employers look to their brokers to provide more services with less commissions. On top of that, HR broker tech startups, such as Zenefits, Namely and Gusto are taking business away. These firms offer technology solutions for free and become the broker of record — and they are moving upmarket, Collins added. The tech startups, Collins added, are taking business from more traditional brokers.

These tech startups are directly approaching adviser’s clients, she said. Clients are responding to these HR tech startups because of challenging and changing requirements of HR, including Affordable Care Act compliance.

“Clients are asking for more than ever,” she said. “It used to [broker’s] sold insurance. Now they are a true consultant and risk mitigator.”

“Clients want more and more and it is challenging with less commission dollars to work with,” she added. “You have more competition than you have ever had.”

Advisers need to provide value, as benefits are likely to be a top three expense for an employer, added Brian Slutz, regional sales manager at hCentive.

The future
Looking toward the future, many questions still remain about President Donald Trump’s plans for healthcare and employee benefits, but a few things are likely to be consistent, which can be streamlined with technology, including:

  • Consumer-driver healthcare is staying, Collins said, and with that comes the growth of health savings accounts. As a result, more voluntary products can be sold. Technology enables that through decision support tools that suggest these products to employees.
  • Cost transparency tools: “A really critical tool,” Collins said. Viable systems are hitting the marketplace now and technology provides answers employees are seeking on healthcare costs
  • Personalized communications: With more choice and more complication comes the need for education, Collins said. Technology solutions are becoming more customized to speak to an individual employee with targeted communication to a particular generation.

See the original article Here.

Source:

Kalish B. (2017 January 31). Why technology is not just a ‘thought but a necessity’ [Web blog post]. Retrieved from address http://www.employeebenefitadviser.com/news/why-technology-is-not-just-a-thought-but-a-necessity?brief=00000152-1443-d1cc-a5fa-7cfba3c60000