***Health Care Reform Update**

The past several weeks have seen several new requirements, changes, and clarification communication within the Health Care Reform arena. We’ve compiled a list of all the items which may affect your organization or health plan, and included a brief outline of each provision. Feel free to follow our blog for more information, and contact us with any questions.

New Reporting Requirements

Employers and self-insured plan sponsors are required to report minimum essential coverage and/or insurance coverage to the IRS and employees. The first reporting will be required in 2016 for the 2015 calendar year, and employers are encouraged to voluntarily report coverage information in 2015 for the 2014 calendar year.

Employers with 50 or more full-time (including full-time equivalent) employees need to report all of the employees offered coverage throughout the calendar year to the IRS. Self insured employers would complete both sides of the form, and provide a copy to employees. The form will encompass the following information:

• Employer information, including contact information and the number of full-time employees
• The lowest cost employee monthly premium for self-only coverage for minimum value coverage offered to the employee
• Information on each full-time employee to whom coverage was offered and identifying information, such as Social Security Number
• Information about the insurer or entity providing coverage, including contact and other business information
• Which individuals are enrolled, identifying information of those individuals, and the months in which they are enrolled

Minimum essential coverage must also be reported annually to both the IRS and any individual named in the report as having such coverage.

Employers who offer minimum value, affordable coverage to at least 95% of their full time employees and their dependents during all 12 months of the year may take advantage of simplified reporting. Employers who qualify for simplified reporting do not have to report employee’s FT status.. They can report basic employee identification data and the fact that they received a full-year qualifying offer. These employers can also give the named employees a copy of that notice or a standard statement confirming the full-year qualifying offer.

2015 Cost-Sharing Limits

For 2014, non-grandfathered plans must include a member cost-sharing limit of no greater than $6,350 for individuals, and $12,700 for family coverage. In 2015, this amount will increase by 4.21 percent to $6,600 for individual coverage and $13,200 for family coverage.

Confirmation of New Fees:

A)      Reinsurance Assessment Fee

Final legislation regarding the Reinsurance Assessment Fees have been announced recently. The fee is applicable to insured and self-funded major medical plans for calendar years 2014 through 2016. It will primarily be used to help lessen the impact of high-dollar claims occurring within the individual market. The 2014 fee is $63 per person, with scheduled collection in two installments: $52.50 in January, 2015, and $10.50 late in the fourth quarter of 2015. The 2015 fee will be $44 per person.

The user fee paid by insurers that offer plans on the federal Marketplace is confirmed at 3.5% of premiums. This is the same rate as in 2014.

B)      Federal Marketplace User Fee

The user fee paid by insurers that offer plans on the federal Marketplace is confirmed at 3.5% of premiums. Fully insured carriers are responsible to pay this fee, and will build it into premiums.

Actuarial Value Calculator

The Actuarial Value Calculator was updated. We will provide our clients with their plan’s Minimum Value (MV). Please feel free to discuss with your account manager.

Waiting Period Regulation

Although initial legislation limited the new hire waiting period to 90 days, the HHA has passed additional guidelines regarding new hire orientation periods. Most notably, a new hire may be required to meet an orientation period no greater than 30 days before their waiting period for benefits may begin.

Additionally, the final rule confirms the following specifics:

·         Calendar days are counted in determining the 90-day period, including weekends and holidays. Plans may choose to permit coverage earlier than the 91st day for easier administration around events such as weekends, holidays or payroll periods. However, a requirement that coverage will become effective the first day of the following month or payroll period would not be permitted if the waiting period is 90 days. The employer defines the eligibility criteria.

·         The time in which eligible employees take to elect coverage is not counted as part of that 90-day limit.

·         If a person enrolls as a late or special enrollee, any time period before the enrollment date is not counted as part of the 90-day limit.

Employees that were once terminated then rehired may be treated as a new hire subject to the plan’s eligibility and waiting period requirements. The same applies to employees moving between eligible and non-eligible employment positions.

HIPAA Certificates of Creditable Coverage

Since plans are no longer allowed to impose preexisting limitations, the HIPAA certificate requirement will phase out at the end of 2014.