New Guidance on Cost Sharing Limits under Health Care Reform

Ed MacConnell

The three agencies responsible for the implementation of health care reform (Treasury, Health and Human Services, and Labor) released a joint set of Frequently Asked Questions on cost sharing limits. Health care reform places a limit on the dollar amount of out-of-pocket expenses that a participant may be charged in a year. In 2014, that limit is $6,350 for self-only coverage and $12,700 for other coverage. In 2015, the limit increases to $6,600 for self-only coverage and $13,200 for other coverage. The guidance clarifies that if an out-of-network provider charges an amount greater than the amount allowed by the plan (i.e., balance bills the amount above the usual and customary… Read More

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IRS Highlights Stiff Penalty for Reimbursing Individual Premiums

Ed MacConnell

From Health Care Reform Digest: Since the IRS and Treasury published Notice 2013-54 in September 2013, pre-tax employer reimbursement of an employee’s individual health insurance premiums has been a hot topic of conversation.  Historically, many employers have provided this type of benefit in lieu of offering a group health plan – a strategy that now needs to be reevaluated as a result of regulations implementing the Patient Protection and Affordable Care Act (PPACA).   Q1.  What are the consequences to the employer if the employer does not establish a health insurance plan for its own employees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health… Read More

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