CIGNA Webinar: 2 Distinct forms of ACA Reporting

From CIGNA-Informed on Reform Series. You’ll want to use the “maximize” or full screen feature to view the video in the bottom right hand corner of the menu bar.  

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Health Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax

Health Care Reform: Taxes and Fees-PCORI Fee, Transitional Reinsurance Fee, Insurer Fee and Excise Tax   From United Healthcare: Taxes and fees under the health reform law impact both fully insured and self-funded plans. But, they impact funding types differently. Employers with self-funded health plans submit applicable health reform fees directly to the government, and those with fully insured health plans will see fees prorated into their premiums. The fees are prorated over 12 months. Here is what you need to know about these fees and how they will impact your business. Please note that this document, provided by United Healthcare, has carrier specific language, however please contact your Total Benefit… Read More

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Download our Mid-Year Compliance Bulletin Compilation

Our Mid-year Compliance Bulletin Compilation is now available, featuring all of our released compliance bulletins for January through June. This document acts a resource for you to have all of the latest health reform information and updates in one place. You can click on a bulletin title in the table of contents and it will bring directly to the corresponding page. Click the link below to download the document.   2015_Compliance_Compilation_mid_year

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IRS Releases Draft 2015 Forms 1094-C and 1095-C

Last week, the IRS issued draft 2015 Forms 1094-C and 1095-C. The forms are substantially the same as the 2014 forms,except for a couple of changes. Please click the link below to read the bulletin. IRS Releases Draft 2015 Forms 1094-C and 1095-C – 062615R Not sure what forms you need? Fee free to contact your Total Benefit Solutions account manager at (215)355-2121 or check our health care reform compliance center.

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Supreme Court Upholds Subsidies

Supreme Court Upholds Subsidies On June 25, 2015, the Supreme Court confirmed in a 6-3 decision that premium tax credits and cost-sharing subsidies (referred to as “subsidies”) are available in the federal Health Insurance Marketplaces (also referred to as the “Exchange”). This ruling effectively removes any challenges to the ability of Exchanges to offer subsidies to qualified individuals. Please click the link below to read the entire bulletin. Supreme Court Upholds Subsidies – 062515R     Remember,Total Benefit Solutions can help all people get enrolled on a qualified health plan, on or off the healthcare.gov marketplace. Call us today for more information at (215)355-2121.

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Lost your health coverage?

  Losing other health coverage, including losing a job-based plan, aging off a parent’s coverage at 26, losing coverage through divorce, losing eligibility for Medicaid or CHIP, and similar events. Coverage can take effect: The first day of the month after you enroll and after the loss of coverage Enrollment window: From 60 days before to 60 days after losing your other coverage Important: If you leave your job for any reason and lose your job-based health coverage, you qualify for a Special Enrollment Period. But you don’t get an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan; unexpired COBRA coverage; or… Read More

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Lost your health coverage?

  Losing other health coverage, including losing a job-based plan, aging off a parent’s coverage at 26, losing coverage through divorce, losing eligibility for Medicaid or CHIP, and similar events. Coverage can take effect: The first day of the month after you enroll and after the loss of coverage Enrollment window: From 60 days before to 60 days after losing your other coverage Important: If you leave your job for any reason and lose your job-based health coverage, you qualify for a Special Enrollment Period. But you don’t get an SEP if you voluntarily drop: a job-based plan without leaving your job; an individual insurance plan; unexpired COBRA coverage; or… Read More

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Gov. Wolf wants Pa. to operate Obamacare exchange

Gov. Wolf this week formally proposed setting up a state-based insurance marketplace, potentially protecting hundreds of thousands of Pennsylvania residents from the consequences of a Supreme Court decision that could gut Obamacare later this month. Read more at philly.com Remember that your Total Benefit Solutions professionals are trained, licensed, insured and available to help compare, shop and enroll all affordable care act plans on the healthcare Marketplace and off.  As always contact us today if you have any questions or concerns at (215)355-2121.

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PPACA dropouts cut enrollment by 1.5 million

(Bloomberg) — About 1.5 million people dropped off health insurance coverage rolls this year after failing to pay for policies they picked on the Obamacare marketplaces. That left 10.2 million covered by Affordable Care Act policies as of March 31, up from 6.3 million at the end of 2014, the Centers for Medicare & Medicaid Services said today. Eighty- five percent got subsidies to help them afford coverage. Click here to read the story.

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FAQs Further Clarify New Embedded Out-of-Pocket Requirement

As reported earlier, starting with the 2016 plan year, the self-only annual limitation on cost sharing for non-grandfathered plans ($6,850 for 2016) applies to each individual, even if the individual is enrolled in family coverage. On May 26, 2015, the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments) issued new FAQs further clarifying this new rule, confirming that it applies to all non-grandfathered group health plans, including self-insured plans, large group health plans, and high deductible health plans. Click the link below to download the bulletin for further guidance. FAQs Further Clarify New Embedded Out-of-Pocket Requirement – 060115R  

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Cadillac Tax Preliminary Guidance: Part II

The IRS issued Notice 2015-16 to begin the process of developing regulatory guidance regarding the excise tax on high cost employer-sponsored health coverage, commonly known as the “Cadillac Tax.” Beginning January 1, 2018, a 40% excise tax will apply on the cost of applicable coverage that exceeds prescribed thresholds (described later in this article). Click the link below to download the bulletin: Cadillac Tax Part II  

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Small business tax concerns with SHOP

Initially created with the goal of helping small businesses comply with the requirements of the Patient Protection and Affordable Care Act (PPACA), the Small Business Health Options Program (SHOP) has not been meeting expectations. Click here to read the full story on Benefits Pro As always your Total Benefit Solution team is available to answer YOUR questions about the Small Business SHOP at (215)355-2121.

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Health Reform: Q+A: Are we able to give a bonus to employees to sign up for health insurance?

The following question came to us recently from a small group client. Send us your question and we may use yours in the future! Question: Are we able to give a signing up bonus to encourage employees to sign up for health insurance or will that be an issue with health care reform? Answer: An employer may provide bonuses at its discretion as long as the amount is reported as taxable compensation. Federal law prohibits employers from providing incentives to certain employees (such as Medicare-eligible persons) to discourage them from enrolling for group health coverage, but there is no prohibition against incentives to encourage enrollment. The bonus would be taxable compensation… Read More

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Health Care Reform: 2016 Cost-Sharing Limits, Reinsurance Fee,and Other Changes Related to the Exchange

On February 27, 2015, the Department of Health and Human Services (“HHS”) changed cost-sharing and transitional reinsurance program fee limits and released standards for health insurers and the Exchange (a.k.a. the Health Insurance Marketplace). This article identifies a few items of note for employers. 2016 Cost-Sharing Limits, Reinsurance Fee, and Other Changes Related to the Exchange – 040915R

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Relief for Small Employers Reimbursing Individual Policies

An employer cannot offer employees cash to reimburse the purchase of an individual policy, whether or not the employer treats the money as pre-tax or post-tax to the employee. Such arrangements (called “employer payment plans”) are subject to the market reform provisions of the Affordable Care Act (“ACA”), including prohibition on annual limits and the requirement to provide certain preventive services without cost sharing with which it cannot comply. These arrangements may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee). Click the link below to read the bulletin: Relief for Small Employers Reimbursing Individual Policies – 031915R  

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Employer Guide to Pay or Play Shared Responsibility

The Affordable Care Act’s Employer Shared Responsibility (ESR) provision — often called “the Employer Mandate” or “Play or Pay” — requires large employers to offer health coverage to their full-time workers or face a potential penalty. Small employers with fewer than 50 full-time and full-time-equivalent employees are exempt. Play or Pay takes effect January 1, 2015, although special transition relief rules will allow some employers to delay compliance for several months or into 2016. The concept behind Play or Pay is simple: To play, the employer must offer health coverage to full-time employees that work on average 30 or more hours per week. Employers that fail to offer coverage, or… Read More

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Is your small business eligible for the health care tax credit? Find Out-Health Care Tax Credit Estimator

Does your small business: Have 25 employees or less? Pay at lest 50% of the employee’s health insurance premium? Have average employee earnings of under $50,000 annually?   Then you may be eligible for the health care tax credit! Click here for the CMS HCTC estimator tool. As always contact your Total Benefit Solutions account manager at (215)355-2121 if you have any questions about the SHOP Marketplace of the Small Business Health Care Tax Credit.

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IRS Penalties for Small Employers Reimbursing Individual Health Insurance Premiums Will Not Apply Until July 2015

IRS Penalties for Small Employers Reimbursing Individual Health Insurance Premiums Will Not Apply Until July 2015 IRS Notice 2015-17 provides limited transition relief from the assessment of excise taxes for small employers who reimburse, or directly pay, the premium for an employee’s individual health insurance policy. Prohibited Plans An “employer payment plan” is an arrangement under which an employer reimburses an employee for some or all of the premium expenses incurred for an individual health insurance policy, or an arrangement under which the employer uses its funds to directly pay the premium for an individual health insurance policy covering the employee. Pursuant to prior agency guidance, employer payment plans are… Read More

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PA Governor Wolf Delivers Victory for CHIP Buy-In Program, Ensures Families will Keep Coverage and be Held Harmless

PR Newswire Association LLC HARRISBURG, Pa., Feb. 13, 2015 /PRNewswire-USNewswire/ — Governor Tom Wolf today announced that as a result of his administration’s continued efforts, the federal government has agreed that Pennsylvania families enrolled in the Children’s Health Insurance Program (CHIP) Buy-in Plan will not face tax penalties in 2015 while the program is brought into compliance with minimum essential coverage (MEC) under the Affordable Care Act.   For Full Story Click here

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How do Tiered Network plans like the Keystone HMO Proactive and Horizon Omnia plans work?

Tiered or Narrow Network Plans: Under the Affordable Care Act, insurance carriers have introduced “tiered network”, or narrowed network plans. Keystone Proactive HMO Plans from Independence Blue Cross  have a unique  ” 3 tiered” network of providers. Although each carrier has different types of networks and benefit levels, the plans have the same general concept, steering the members by giving them a choice of providers that offer medical services at a lower out of pocket expense. Choosing a more expensive provider or facility may cost the member more out of pocket costs. United Healthcare offers 2 tiers in their “Navigate” plans, and Aetna uses “Savings Plus” designated providers to split… Read More

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New tax form for individuals with coverage from the Health Insurance Marketplace

Beginning in January 2015, the Health Insurance Marketplace Health and Human Services will be issuing a new 1095-A tax form to individuals who purchased coverage through the Health Insurance Marketplace. If you or anyone in your household enrolled in a health plan through http://www.healthcare.gov you should receive the new tax form in the mail. You should use this form when filing your 2014 federal income tax return. For more information visit www.IRS.gov/ACA or www.healthcare.gov/taxes or contact your tax advisor. The following publications are also available: Health Care Law: What’s New for Individuals & Families  This is a large publication with many details. 3 Tips: The Marketplace and taxes Regarding your tax forms and… Read More

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2014 Compliance Bulletin Compilation

Download our 2014 Compliance Bulletin Compilation, featuring all of our released compliance bulletins for the entire year!  Topics include, Health Savings Accounts, The Individual Mandate, Employer “pay or play” mandate, exemptions, FSA carryovers and much, much more. All of the bulletins are in an easy to search format for your convenience. 2014 Compliance Compilation – Download As always please contact your Total Benefit Solutions account manager at (215)355-02121 if you have any further questions or concerns.

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Plan cost inaccuracies found on HealthCare.gov

Consumers who have complex medical diagnoses that require specialty drugs should carefully examine the health insurance plans offered through the public exchange system to avoid incurring high costs for those drugs. But that task will be complicated by inaccuracies on the public exchange website. That’s the conclusion of an analysis of public exchange plans by Avalere Health. The study, in which researchers went through all available plans looking for “hidden” drug costs, found that silver plans in particular tend to place such drugs in specialty tiers in their 2015 formularies. Avalere said that 17 percent of silver plans contain two or more specialty drug tiers that will drive up out-of-pocket… Read More

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Total Benefits Introduces New Compliance and Health Reform Education Center

Total Benefits Comply is our new Compliance and Health Reform Education Center where we will keep a copy of our health care reform bulletins throughout the year, in an easy  to view format, along with short informative videos. This new resource makes it easier to quickly find the answers to your reform questions and download a short, to the point bulletin. At Total Benefit Solutions Inc., we are dedicated to providing the information and advice that our clients need to remain compliant and make informed healthcare decisions. If you have any further questions please contact you Total Benefit Solutions account manager  at (215)355-2121 Click here for Total Benefits Comply.

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IBC: Important information about member outreach for IRS reporting

From Independence Blue Cross: As you may know, the Affordable Care Act (ACA) requires all health insurers to report certain information about health care coverage to the Internal Revenue Service (IRS) for individuals with fully insured commercial health plans. This information includes an individual’s Tax Identification Number, which is typically the Social Security Number (SSN). The purpose of the IRS reporting is to help ensure that Americans have minimum essential coverage as required by the ACA. This is commonly referred to as the individual mandate. Independence Blue Cross (Independence) has determined that we do not have SSNs on file for some of your customers’ employees and/or their covered dependents. The… Read More

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