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
