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Nonstop Blog:

Are You on Track with Healthcare Reform Requirements?


As we approach the mid-way point of the 2015 tax year, it’s a good time to check in on health reform mandates to ensure you are in compliance with ACA.  Whether your organization is fully-insured, self-insured, or partially self-insured, there are a number of mandates that are worth clarifying and confirming as you move forward with your health insurance plans.

 If you have self-insured group health coverage for employees, below are the key areas to check into to determine compliance. Most of these have been in effect since 2013 or 2014 and/or may have rolling deadlines (unless otherwise noted). 

·      Benefits requirements (prohibitions on employer payment plans; 90-day limits on coverage waiting periods; prohibitions on annual dollar limits; elimination of preexisting condition exclusions; W2 reporting of health coverage**; staying updated on new preventive services that require coverage; annual limits on cost-sharing for “essential health benefits”)

·      “Pay or Play,” and Information Reporting Requirements (compliance with “Pay or Play” unless your company meets eligibility criteria for transition relief*; determine if any “pay or play” penalties apply for 2015*; monthly tracking of full-time employees and their health coverage offerings; determine reporting methods, including if a TPA will file returns and furnish statements (by February 29, 2016 or March 31, 2016 if filed electronically); ensure consent is obtained before furnishing statements electronically (by February 1, 2016))

·      Employee notices (notice of coverage options for new employees; confirmation that TPA will prepare/provide Summary of Benefits and Coverage (SBC) at specified times; update SBCs to include language around provisions for “minimal essential benefits” and “minimum value” standards; notices of modification for any changes that affect content of the SBC)

·      Financial provisions (withholding of additional Medicare taxes; fees to support the Patient-Centered Outcomes Research Institute (PCORI) (only for certain self-insured plans); fees for the Transitional Reinsurance Program (only for certain self-insured plans))

·      Tax favored arrangements (ensure appropriate plan amendments are adopted if mid-year changes in salary reduction elections are made; prohibitions around providing qualified health plans under employer-sponsored cafeteria plans; HRAs cannot be used to fund individual policy premiums; FSAs must qualify as an excepted benefit and are offered through a cafeteria plan; amendments on plan documents to reflect annual $2,550 limit (for 2015) on FSA contributions; determine if FSA carry-over will be permitted for employees and amend plan documents accordingly)

For specific questions about the above topics and deadlines, and to learn more about health reform and self-insured plans, please contact us.

 *For large companies of 50+ employees only

**This does not apply to organizations that filed fewer than 250 W2s the preceding calendar year

The information and materials herein are provided for general information purposes only and are not intended to constitute legal or other advice or opinions on any specific matters and are not intended to replace the advice of a qualified attorney, plan provider or other professional advisor. This information has been taken from sources believed to be reliable, but there is no guarantee as to its accuracy. In accordance with IRS Circular 230, this communication is not intended or written to be used, and cannot be used as or considered a ‘covered opinion’ or other written tax advice and should not be relied upon for any purpose other than its intended purp