Those penalties can be stiff if you become a target of the IRS

The Internal Revenue Service has threatened employers with Affordable Care Act penalties of $36,500 per employee, per year, nondeductible. Makes those $2,000 and $3,000 penalties look like small potatoes, right?

The targets of this particular Q&A are employers who maintain “non-integrated” “employer payment plans.” These are new terms, which include reimbursement plans such as health reimbursement arrangements (HRAs, excluding retiree-only and excepted benefits HRAs). Those should generally have been eliminated by Jan. 1, 2014, or amended to be integrated with group health coverage.
The federal agencies dropped this bomb on employers on the cusp of open enrollment season last year, and many employers had to scramble into compliance. You could have done the math on the $100 per day excise tax. But the IRS puts this $36,500 figure into a Q&A for a reason: it wants to scare you. And employers need to know that a non-integrated employer payment plan is just one of many potential triggers of these potentially devastating excise taxes.


When I first blogged about health care plan self-audit, self-correction, and self-reporting compliance issues on Form 8928, no one seemed too interested. It’s time to get interested.


Caresani, a partner Porter Wright Morris & Arthur’s Cleveland/Akron, Ohio area, focuses her practice on employee benefits, ERISA and executive compensation. As editor of the firm’s employee benefits blog — Employee Benefits Law Report — and the ERISA preemption chapter of ERISA, A Comprehensive Guide (published by CCH), Caresani consistently reviews recent cases, legislation, regulations, and other employee benefits law developments and helps our clients understand how these changes may impact their organizations.

IRS Highlights Stiff Penalty for Reimbursing Individual Premiums

IRS Highlights Stiff Penalty for Reimbursing Individual Premiums

Exchange Rx may cost more than employer sponsored plans.

Silver plans offered through the exchanges may require patients to pay more than twice as much out of pocket for prescription medicines as they would under a typical employer plan, offering employers a prime opportunity to use health care benefits as retention and recruitment tools for their employees.

Silver plans — the second highest coverage tier on the Affordable Care Act’s public health insurance exchanges — impose 130% higher cost sharing for prescription medicine, along with a combined deductible, than typical employer-sponsored plans, according to a new report by the Seattle, Wash.-based Milliman Inc., a consulting company. The Milliman report also notes that silver plans are nearly four times more likely to have a single combined deductible for medical and pharmacy benefits (46% of the time) compared to typical employer-sponsored plans (12%).
See related story: Access to Rx drugs challenged by the exchanges
Employees with chronic conditions requiring the use of medications could be motivated to seek out employers offering high quality health care coverage rather than those that have opted to send their employees to the exchanges, says Brenda Gagnon, a pharmacy-focused benefit adviser and president and CEO of the health care consulting firm B.M Gagnon Associates.
“Employers have started recognizing that offering great health care coverage has become an attraction tool for high quality talent and retention for current employees,” she says. “This movement started in mid-year 2013 and will pick up speed faster this year.”
She adds: “Advisers that don’t take this knowledge and bring it into their business practice will be left behind.”
“Americans participating in the exchanges were promised coverage comparable to employer plans and yet the reality is that many new plans are failing to provide an appropriate level of access to quality, affordable health care,” says John Castellani, president and CEO of Pharmaceutical Research and Manufacturers of America (PhRMA), the Washington, D.C.-based trade association that commissioned the report.
“Patients face hurdles in accessing the medicines they need to manage their conditions, which is particularly problematic for Americans trying to control their chronic diseases,” he adds.
According to Milliman’s analysis, the typical deductible for silver plans is $2,000.
Previous studies have found that higher out of pocket costs reduce patients’ likelihood of taking prescription medicines to manage chronic conditions. The result is an increase in hospitalizations and higher health care costs overall, a common reason employers often exclude pharmacy benefits from deductible requirements — in the long-term it saves the employer money on increased medical costs.
Programs that encourage better adherence to medication management for chronic conditions have also been found to reduce emergency department visits, hospitalizations and other preventable, costly care, the Milliman report adds.
According to a 2012 Health Affairs study, improved medication adherence for patients with diabetes has the potential to save $8.3 billion each year.
The Milliman report analyzed the differences between common health care benefit designs offered to individuals through the exchanges and typical employer-sponsored plans. The report looked at silver plans because they were the most popular in the enrollment period that ended March 31 of this year.

COBRA SEP in CA?

Posted: 16 May 2014 06:21 AM PDT

**Question**: Is the COBRA SEP adopted by CA the same as the feds? **Answer**: No. The COBRA SEP in CA extends from May 15 to July 15 (SEP in fed exchanges ends July 1st)So people **currently enrolled** in COBRA coverage have until July 15 to apply for coverage through Covered California or off-exchange in a ACA compliant plan.

Uninsuree rate at five year low while ACA remains unpopular

Uninsured rate at five-year low while ACA remains unpopular

Obamacare reduced the percentage of U.S. adults without health insurance to its lowest point since 2008 even as the law remains unpopular with the public, separate surveys showed. READ MORE »

ACA effects on employers still to come

All of the delays related to the Affordable Care may be seen a sign of the law's failure, but one employment law expert said Monday employers can view the delays as a good thing – an extra year or more to figure out what to do. READ MORE »

Feds: Employers must notify laid-off employees of exchange option

Laid-off employees are eligible to continue participating in employer-sponsored health plans after they are laid off, but employers must now also inform employees that they can enroll in a plan through an Affordable Care Act exchange, under recent guidance from the departments of Labor and Health and Human Services. The Wall Street Journal (tiered subscription model) (5/2)

California Employee Benefits from AMSINSURE.COM: 2015 to see expansion by some Health Insurance Car...

California Employee Benefits from AMSINSURE.COM: 2015 to see expansion by some Health Insurance Car...: Major insurers to expand Obamacare markets in 2015   Despite dire predictions on...

2015 to see expansion by some Health Insurance Carriers in the State Exchanges

Major insurers to expand Obamacare markets in 2015

Despite dire predictions on insurers’ future in the public exchange, two leading carriers are actually expanding their presence.

Read more April 17, 2014     Committed to news, opinion and business analysis

Off exchange enrollmetn does well, and little noticed with eyes on the health care exchanges

All eyes were fixed on final 2014 HIX enrollment numbers in the waning days of March and what they would mean for adverse selection and future monthly premium pricing. But such data has eclipsed significantly important details about the post-health care reform marketplace that have been largely overlooked.

Case in point: It has been estimated that millions of Americans who aren’t eligible for HIX subsidies chose health insurance options off the exchanges, including young and healthy adults who are most desirable in any insurance risk pool.
The potential implications of this phenomenon are worth noticing. While only about 25% of those between the ages of 18 and 34 signed up for coverage on public exchanges, according to the federal government’s most recently released enrollment figures, about 40% of that same age group bought off-exchange plans in the fourth quarter through the online comparison-shopping site eHealth. A survey of eHealth customers found that 63% mistakenly thought that they could only enroll in HIX plans through government exchanges.
Health insurance carriers also say that a fair number of new signups do not involve HIX options. WellPoint, for example, recently reported that about 20% of the roughly one million customers it expected to enroll new plans nationwide would be off the exchanges. The number was even higher for Highmark, which noted that approximately 30% of 133,000 members who enrolled as of the middle of last month chose coverage outside the exchanges.
The trend is understandable. Jay Jensen, a managing member of Insight Benefits Group, LLC, says carriers that have shunned the HIX model are able to offer competitive pricing off the exchanges by targeting healthier customers with higher incomes who are going to have a better claims experience than unhealthy lower-income earners who could trigger adverse selection.
His employee benefits and risk management firm has partnered with two Web-based entities, Quotit and Norvax, to help employees shop for health insurance on or off the exchanges with the help of licensed professionals.
Consumers may barely notice any differences between HIX and off-exchange options, aside from whether they’re eligible for federal subsidies. The same plans available on public exchanges often can be purchased off those exchanges through a local health insurance agent, according to Brian Mast, vice president of communications for eHealth Inc. “In some cases there may be more options outside of exchanges because certain carriers have opted out of state exchanges, but are still offering ACA plans,” he says.
Whatever the final enrollment numbers for both HIX and off-exchange options turn out to be, industry analysts surely will comb through every detail for the most accurate picture of how the new online marketplace might evolve.
Clare Krusing, a spokeswoman for America’s Health Insurance Plans, says the focus needs to be broader than just the number of people enrolling and also include, as suggested, the age and health status of enrollees. Another critical point is that the impact of enrollment will vary by state. “What may happen in Illinois with this risk pool isn’t going to have the same impact as, say, California,” she says.
Shutan is a Los Angeles freelance writer.

Bill bumping ACA to 40-hour work week passes House

Bill bumping ACA to 40-hour work week passes House   The U.S. House of Representatives on Thursday passed legislation that would modify the Affordable Care Act’s definition of a full-time employee from one who works 30-hours a week to one who works 40-hours a week. READ MORE »

More employers embracing ACA provisions in health plan designs

More employers embracing ACA provisions in health plan designs

While it’s not surprising that in 2013 the trend of employers shifting rising health care costs to employees continued to grow, it also appears employers have begun to design health care plans with looming Affordable Care Act provisions in mind. READ MORE »

Top Stories in Health Care Reform

In a sign of just how difficult it is to rein in out-of-pocket costs, 35% of 2014 bronze-level plans in the Small Business Health Options Program had deductibles that exceeded suggested annual caps under the Affordable Care Act. READ MORE » For millions of low-income Americans, the road to health care reform in 2014 could prove to be a jagged line through which they bounce between public exchanges and Medicaid as their income fluctuates over the year. While the effect on care consistency, quality and cost generates concern for those forced to switch health plans or doctors, it may pale in comparison to the “churning” phenomenon long seen in Medicaid when program eligibility is lost and then regained. “The challenge historically has been that people have churned between coverage and nothing, and that’s a big problem,” explains Matt Salo, executive director of the National Association of Medicaid Directors. “Now while churn is still a problem, it’s a much better problem to have as people are moving between Medicaid coverage and exchange coverage.” He acknowledges key differences in terms of cost sharing and benefits, as well as movement among different provider networks, but points to a number of solutions aimed at encouraging a segmented industry to straddle these lines. Examples include Nevada’s requirement that Medicaid managed care companies offer a comparable HIX plan, Washington’s program to create seamless plans with identical networks and Delaware’s plan to ease any HIX transition from Medicaid by covering approved medical treatment and medications. There’s also bipartisan legislation, sponsored by two Texas congressmen, U.S. Rep. Gene Green, a Democratic, and U.S. Rep. Joe Barton, a Republican, to help stop churning. Their plan would require states to guarantee a year of continuous eligibility to people on Medicaid – a requirement in about two dozen states for children on Medicaid and the Children’s Health Insurance Program. “Do Medicaid-only plans want to start offering coverage in the exchange and do predominantly private-sector plans want to start playing in Medicaid?” Salo asks. “If you can make that happen, you drastically minimize churn if you can move an individual from a company’s Medicaid product into that company’s exchange product, or vice versa. “Plans should want to do this, and some already are,” he continues. “Compelling them to do so is technically a tool that states can utilize, but it’s a pretty drastic one, and most states won’t pursue that. Other states are looking at less invasive policies, such as requiring that any plan cover a previous plan’s therapeutic or pharmaceutical plans of care for some period of time after the churn, even if those aren’t in the plan’s benefit package.” An estimated nine million people are expected to shift between the exchanges and Medicaid during 2014, Matthew Buettgens, a senior research analyst at the Urban Institute, noted in a recent Kaiser Health News story produced in association with The Washington Post. While nearly 30 million Medicaid beneficiaries are enrolled in private managed care plans, Medicaid expansion plans under the Affordable Care Act are expected to make millions more eligible for such coverage. The report suggested that convincing these health plans to sign up for both markets to help avoid any churning remains a challenge, with just 16 of 60 Association for Community Affiliated Plans members having joined the exchanges. One such explanation is differences between Medicaid contracts and state health insurance rules for commercial plans. Bruce Shutan is a Los Angeles freelance writer.

Affordable Private Exchange

Premier Carriers ApplaudCaliforniaChoice for its Broad Selection, Affordability and Focus on CustomerService
As government-run healthcare exchanges continue to grab the national spotlight, employers in California are increasingly seizing the opportunity to enroll in the...

California rejects Obama plan to extend canceled healthcare policies Los Angeles Times | November 21, 2013 | 2:15 PM California's health insurance exchange voted unanimously Thursday against an extension of canceled health policies affecting about 1 million consumers in the state. The decision ends a weeklong drama over what would happen for policyholders who will lose their existing coverage Dec. 31 and face finding replacement insurance that may cost more. The 5-0 vote by the state exchange marks a break with the president since California has been a strong supporter of the Affordable Care Act. For the latest information go to

IRS change could make health FSAs more popular

The Internal Revenue Service has altered the "use-it-or-lose-it" rule for medical flexible spending accounts, allowing workers to roll over $500 from year to year, write Robert Bloink and William Byrnes. FSAs could become more valuable than ever under the Affordable Care Act because of greater out-of-pocket expenses for many people, Bloink and Byrnes write.

Sorting out ACA subsidies and credits

People with incomes higher than 400% of the federal poverty level may purchase health insurance plans from an Affordable Care Act marketplace, but they will not qualify for federal subsidies, and people whose incomes rise might have to pay back any subsidies they received the prior year. People who have health insurance through an employer do not qualify for subsidies unless that insurance meets the definition of unaffordable, and subsidies are calculated based on the cost of a silver-level plan but may be applied to a lower- or higher-tier plan. Subsidies to help with deductibles and copays are available to people making less than 2.5 times the poverty level, but they apply only to silver-level plans.

Section 125 rule change

The Internal Revenue Service announced last week in IRS Notice 2013-71 additional loosening of rules around cafeteria plans, all size employers with non-calendar year cafeteria plans have the option to amend their cafeteria plans and allow for one off-year election change. Generally, Section 125 cafeteria plan elections must be made before the start of the plan year, and are irrevocable during the plan year, with limited exceptions, including certain changes in status. Under existing regulations, the availability of health plan coverage through an Exchange beginning with 2014 calendar year does not constitute such a change in status. As a result, employees would not be able to change their salary reduction elections for health coverage during a plan year in order to, for example, cease their salary reductions and Section 125 cafeteria plan coverage and purchase coverage through an Exchange. The original transition rule allowing for one off-year election change was published in the employer mandate regulations and only applied to applicable large employers. IRS Notice 2013-71 expands the transition rule to all size employers.

California SB 639 Signed by Govenor effects Health Plans

On September 20, 2013, Governor Jerry Brown signed SB 639 into law.

The bill, introduced by Senator Ed Hernandez (D-West Covina), goes into effect January 1, 2014 and addresses annual deductible and out-of-pocket limits for all non-grandfathered health plans in the individual, small and large group markets.

Essentially, the bill states that any non-grandfathered plan in the individual or small group market that becomes effective or renews on or after January 1, 2014, must limit annual deductibles to $2,000 for individual coverage or $4,000 for families.

Any non-grandfathered plan in the individual, small group or large group market that becomes effective or renews on or after January 1, 2014, must limit annual out-of-pocket costs (for Essential Health Benefits) to $6,500 for Individual coverage, or $12,700 for family coverage.

The exception to this is pediatric care, which will have its own limits. When a non-grandfathered health care service plan or a health insurer in the individual or small group market provides a pediatric oral care benefit meeting the definition as specified in the ACA, the out-of-pocket maximum for the pediatric oral care benefits is $1,000 for one child and $2,000 for more than one child.

Carriers who are not in the Exchange, cannot offer a catastrophic (higher deductible) plan in the Individual market. However, the law allows the DMHC or the CDI higher deductibles for small group products at the bronze level of coverage in order to meet Minimum Value.

Catastrophic plans or policies are defined as “A health care service plan contract or health insurance policy that provides no benefits for any plan year until the enrollee has incurred cost-sharing expenses in an amount equal to the annual limit on out-of-pocket costs, except requires the plan provide coverage for at least three primary care visits.” Catastrophic plans can only be offered if either of the following apply:

• The individual purchasing the plan has not yet attained 30 years of age; or,
• The individual has a certificate of exemption from the federal individual mandate because the individual is not offered affordable coverage or because the individual faces hardship.

The Notice of Exchanges and Subsidies Deadline is Today-By October 1, 2013

Virtually all US employers (regardless of size or whether the employer offers a health plan) are required to distribute a Notice of Exchanges and Subsidies to each employee (regardless of part-time, temporary, full-time or health plan enrollment status). Additionally, beginning on October 1, 2013, this notice must be provided to each new employee within 14 days of the employee’s start date.

There are two model notices available, one for employers that offer a company-sponsored health plan to some or all employees, and one for organizations that do not offer an employer-sponsored health insurance plan. Both of these model notices are available for download in the HR Support Center “Essentials” tab under the “HR Forms” section. (Simply type “Notice of Exchanges and Subsidies” in the Search Box.) There is also an FAQ document regarding this requirement housed in the same location. The purpose of the Notice of Exchanges and Subsidies is to inform employees of the existence of Health Insurance Exchanges (also called Health Insurance Marketplaces) as well as potential federal subsidies available to them in 2014.

Should an employee opt to shop in the Exchange, the employee may use this Notice provided by the employer to enter certain information on the application. The Exchanges are government-provided virtual marketplaces intended to offer individuals and small groups “one-stop shopping” to find and compare private health insurance options.

Open enrollment for health insurance coverage through the Health Insurance Marketplaces begins October 1, 2013 and coverage is available beginning on January 1, 2014.  On September 11, 2013, the DOL announced that there is no specific fine or penalty for failing to provide the notice by October 1, 2013.  However, the DOL or plan participants may bring a civil action against an employer for failure to comply with this notice requirement.
 

Press Release
FOR IMMEDIATE RELEASE

AMSINSURE.COM Receives 2013 Best of Torrance Award

U.S. Commerce Association's Award Plaque Honors the Achievement
NEW YORK, NY, September 10, 2013 -- For the fifth consecutive year, AMSINSURE.COM has been selected for the 2013 Best of Torrance Award in the Employee Benefits Health, Dental, Vision, Pension Insurance category by the U.S. Commerce Association (USCA).
The USCA "Best of Local Business" Award Program recognizes outstanding local businesses throughout the country. Each year, the USCA identifies companies that they believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and community.
Nationwide, only 1 in 1000 (less than one-tenth of 1%) 2013 Award recipients qualified as Five-Time Award Winners. Various sources of information were gathered and analyzed to choose the winners in each category. The 2013 USCA Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the USCA and data provided by third parties.

About U.S. Commerce Association (USCA)

U.S. Commerce Association (USCA) is a New York City based organization funded by local businesses operating in towns, large and small, across America. The purpose of USCA is to promote local business through public relations, marketing and advertising.
The USCA was established to recognize the best of local businesses in their community. Our organization works exclusively with local business owners, trade groups, professional associations, chambers of commerce and other business advertising and marketing groups. Our mission is to be an advocate for small and medium size businesses and business entrepreneurs across America.
SOURCE: U.S. Commerce Association

CONTACT:
U.S. Commerce Association
Email: PublicRelations@uscaaward.com
URL: http://www.uscaaward.com
###

Don Wachtel was determined to take care of his family

by LIFE Happens

Don Wachtel was determined to take care of his family, and purchased a term life insurance policy. As fate would have it, the policy ended up taking care of him. When he was diagnosed with an inoperable brain tumor, he was able to access a portion the death benefit early to help with his care and his family's transition.   view here

Hospitals supersize, fueling rising cost of care, AHIP says

From www.amsinsure.com
Hospitals and medical systems are increasingly merging with or buying competitors, potentially driving up health care prices as they gain negotiating power over payers, experts say. "The rhetoric is all about efficiency. The reality is all about higher prices," said AHIP President and CEO Karen Ignagni. Some 20% of U.S. hospitals are likely to seek mergers within the next five to seven years, Booz & Company analysts say. The New York Times (tiered subscription model)

Eating for Optimal Health now availale

Available now...

The 2013 Wellness Report:
Eating for Optimal Health

With thousands of books ... articles ... websites ... reports ... and clinical studies on eating for optimal health, no single person can keep up with all of the new developments in nutritional research. It would be a full-time job--and you probably already have one of those!

realLIFEstories

LIFE Happens has uploaded realLIFEstories | Life Insurance | Boomer Esiason

Boomer Esiason, retired NFL quarterback and current TV analyst, has a passion for life insurance. His mother died when he was just 7, and money was tight growing up because of it.


.

Obama administration launches ACA support tool for businesses

A new government website called the Health Care Wizard gives employers customized information about how the Affordable Care Act applies to them based on company location, size and health insurance plans offered. The tool returns formulas for calculating penalties, compliance dates and new regulations. NEW SITE     AMSINSURE.COM

Easy access tool on Health Care Reform for Business

Health Care Changes: A New Tool for Small Business Owners

We're excited to announce a new, streamlined health care tool , housed at Business USA,  to help you find out exactly what you and your employees need to know about the Affordable Care Act. In a few quick steps, you'll understand the essentials of new insurance options and other health care changes.

> Try the new health care tool

Government site to help employers with Health Care Reform

http://business.usa.gov/healthcare

The Obama administration just launched Business.USA.gov/healthcare, which is intended to be a one-stop-shop website that will provide employers of all sizes educational materials on how the Affordable Care Act may affect businesses and help them compete. The site includes a wizard tool that is tailored based on size and location, so businesses can learn how the law helps them provide affordable coverage options to their employees while still meeting their bottom line.

Health Care Changes Wizard | BusinessUSA

business.usa.gov

Health Care Changes Health Care Changes Affordable health care is a top concern for businesses. In a few quick steps, this wizard can help you understand what you need to know about new insurance options and other health care changes as well as find health

realLIFEstories | Life Insurance | Brigette Hunter - Keeping a Family an...

Comedy website looks to make health insurance a laughing matter

Writers for the comedic video website Funny or Die are working on video scripts to encourage the site's audience to enroll in health insurance coverage. The material will not be political and instead will "focus more on the positive stuff and really how it relates to young people who aren't thinking about health care in a serious way," said Mike Farah, president of production. The Hill/Healthwatch blog (7/25)

SHOP tax credits explained

Firms with fewer than 25 employees can get up to a 50% tax credit next year if they join the Small Business Health Options Program, Small Business Administration Senior Policy Adviser Meredith Olafson said during a webcast. Some of the SHOP exchanges will offer only one plan next year, but employers should have multiple plans from which to choose in 2015, Olafson said. Average annual wages at qualified businesses must be $50,000 or lower, excluding owner, partner and family income; and employers must cover a certain percentage of employees' premiums. InvestmentNews (free registration) (

Can an Assisted Living Community Transfer my Mother without my Approval?

 

Question: My question is whether an Assisted Living Facility can transfer my mother to another facility without my approval, her financial and health care Agent. Apparently, Mom, who is 87 years old and has dementia, has been somewhat rowdy recently and apparently because of this behavior/acting out, the Assisted Living Facility has made a unilateral decision (without my input at all) to transfer her to another facility on the other side of town. Can this be done and what is my recourse?

Answer: In Florida, a resident in an assisted living facility has the right to at least 45 days’ notice of relocation or termination of residency unless a physician certifies that the resident requires an emergency relocation to a facility providing a more skilled level of care or the resident engages in a “pattern of conduct that is harmful or offensive to other residents.”. So, in your particular case, if the ALF has provided proper notice, they can transfer her for any reason or no reason. If they have not provided proper notice and it is not an emergency transfer as described above then you may have recourse. I suggest that you contact the Long Term Care Ombudsman Program through the Department of Elder Affairs for more specific guidance in your mother’s case. They can be reached at 1.888.831.04040 or at http://ombudsman.myflorida.com. There is no charge for these services.

- See more at: http://www.eldercarematters.com/eldercareanswers/2013/07/26/todays-qa-can-an-assisted-living-community-transfer-my-mother-without-my-approval/#sthash.3670sl0E.dpuf

Health Insurance Exchanges and how people buy Healt Insurance

Excerpt from a survey where people accessed the Health Insurance Exchanges and how they would purchase health insurance from the Washington Post 7/14/13.
                                                             

Still, the focus on price, including the effect of subsidies, is a constant. Consulting firm Booz & Co.'s pretend exchanges showed that premiums were the most important factor in plan selection, followed by cost-sharing features like deductibles. McKinsey & Co., which tested about 150,000 consumers, found most would opt for smaller arrays of doctors and hospitals to achieve discounts.
 

If you are wondering, then I will tell you that this is no different than how people have shopped for health insurance prior to Health Reform. All the fuss and muss over explaining options to most people has nothing to do with how the will shop and buy health insurance on the exchanges.
 

If this happens then it is my best guess that things won't go well and all insures who have higher prices will eventually cut their prices trying to compete or exit the exchange.

5 compliance considerations for employers

Business owners and health care providers should take steps now to comply with the next phase of the Affordable Care Act, attorney Pepper Crutcher writes. Employers should monitor forthcoming IRS guidance on the penalties and taxes it will and will not collect. Employers with "grandfathered" plans should determine the benefits and drawbacks of staying with those plans or making even small changes and losing grandfathered status, determine whether self-insurance is the best option, and consider offering scaled-back options. American City Business Journals/Birmingham, Ala.

§  The crucial difference between ACA tax credits and subsidies
People with incomes between 100% and 400% of the federal poverty level might qualify for tax credits to offset health insurance premiums, and people with incomes between 100% and 250% of the poverty level may also qualify for subsidies to offset out-of-pocket costs. Consumers can apply in advance for the tax credit based on estimated income, and the funds will be sent to the insurer, but if income was underestimated and too much was paid to the insurer, consumers may owe the difference at tax time. Cost-sharing subsidies are also paid directly to insurers, but they need not be paid back if the consumer's income rises or was underestimated. Kaiser Health News/Capsules blog (7/10)        

Cadalic Plans under Health Care Refom

Cadillac insurance plan - Wikipedia, the free encyclopedia

en.wikipedia.org/wiki/Cadillac_insurance_plan‎

 

 

<sup>Informally, a Cadillac plan is any unusually expensive
health insurance plan, usually arising in discussions of medical-cost
control measures in the United States.[1][2][3][4] The term derives from
the Cadillac automobile, which has represented American luxury
since its introduction in 1902,[1]and as a health care metaphor dates
to the 1970s.[1] The term gained
popularity in the early 1990s during the debate over the
Clinton health care plan of 1993,[1] and was also widespread during
 debate over possible excise taxes on "Cadillac" plans during the
health care reforms proposed during the Obama administration.[1]
(Bills proposed by Clinton and Obama did not use the term
"Cadillac".)

The Patient Protection and Affordable Care Act
(as amended by the
Health Care and Education Reconciliation Act of 2010) imposes an
annual excise tax on plans with premiums exceeding $10,200 for
 individuals or $27,500 for a family (not including vision and dental
benefits) starting in 2018.[4]

Criticisms of these plans generally center on the small or
nonexistent co-pays, deductibles, or caps that encourage the
overuse of medical care, driving the cost up for the uninsured or
those on other plans, which some say necessitates a Cadillac tax.[citation needed]

A study published in Health Affairs in December 2009 found that
high-cost health plans do not provide unusually rich benefits to e
nrollees. The researchers found that only 3.7% of the variation in the
cost of family coverage in employer-sponsored health plans is
attributable to differences in the actuarial value of benefits.

Only 6.1% of the variation is attributable to the combination of
benefit design and plan type (e.g., PPO, HMO, etc.). The employer's
industry and regional variations in health care costs explain part of t
he variation, but most is unexplained. The researchers conclude
"…that analysts should not equate high-cost plans with Cadillac
plans, but that in fact other factors—industry and cost of medical
inputs—are as important in predicting whether a plan is a high-cost
plan. Without appropriate adjustments, a simple cap may exacerbate
rather than ameliorate current inequities."[5]</sup>

Healthcare Reform Update: Employers – Controlled Groups and Related Entities

Healthcare Reform Update: Employers – Controlled Groups and Related Entities

March 06, 2013

The Affordable Care Act (“ACA”) provision also known as Employer Shared Responsibility, mandates that employers who generally employ 50 or more full-time equivalents must offer group health insurance benefits to its full-time employees and their dependents or potentially pay a penalty. Employers can determine whether they meet the 50 or more full-time equivalent threshold for January 1, 2014 by using selected information from 2013. An important note, if two or more companies are “related” then the companies may be combined by the government for purposes of determining if the companies are subject to the Employer Shared Responsibility provisions.
Control group and related entities’ rules can be found in the Internal Revenue Code, including but not limited to, sections 414(b) and 414(c), which generally provide that employees of all companies which are members of a controlled group of entities and employees of trade[s] or business[es] (whether or not incorporated) which are under “common control” are to be treated as employed by a single employer. Companies with as little as 20% of common ownership may be considered part of a control group, while companies with 80% common ownership are usually presumed to be “related”. Another area that needs to be considered is affiliated service groups which provide integrated services to the public, parent-subsidiary, brother-sister entities and “family members” with ownership that may be attributed to a related person’s individual ownership interests. In addition, smaller entities with five or fewer persons which could include trusts are also legal entities which should be considered when deciding on who is part of a “control” group.
Lastly, the IRS has proposed anti-abuse provisions which will penalize employers who attempt to avoid the mandates of ACA. As always, please speak with competent legal and accounting professionals to address your specific circumstances.
http://www.irs.gov/uac/Newsroom/Questions-and-Answers-on-Employer-Shared-Responsibility-Provisions-Under-the-Affordable-Care-Act

Obama Administration delays

	Importan Notice, Obama Administration Delays Tax on employers with 50 or more employees as required under ACA.

 

The Washington Post by Sarah Kliff - July 2, 2013: The Obama administration will not penalize businesses that do not provide health insurance in 2014, the Treasury Department announced Tuesday. Instead, it will delay enforcement of a major Affordable Care Act requirement that all employers with more than 50 employees provide coverage to their workers until 2015. The administration said it would postpone the provision after hearing significant concerns from employers about the challenges of implementing it. “We have heard concerns about the complexity of the requirements and the need for more time to implement them effectively,” Mark Mazur, Assistant Secretary for Tax Policy, wrote in a late Tuesday blog post. “We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so.” The Affordable Care Act requires all employers with more than 50 full-time workers provide health insurance or pay steep fines. That policy had raised concerns about companies downsizing their workforce or cutting workers’ hours in order to dodge the new mandate. In delaying the enforcement of that rule, the White House sidesteps those challenges for one year. It is also the second significant interruption for the Affordable Care Act, following a one-year delay on key functions of the small business insurance marketplaces. Together, the moves could draw criticism that the administration will not be able to put into effect its signature legislative accomplishment on schedule.