Posts Tagged ‘Affordable Care Act of 2010’

Reform-Alert-Header-2014

Update to previous alert from July 26, 2013: Federal agencies release proposed rule on 90-day waiting period limitation

On Feb. 20, the Department of Labor (DOL), Internal Revenue Service (IRS) and the Department of Health and Human Services (HHS) jointly released both the final rule and proposed rule on 90-day waiting periods.

The final rule on waiting periods applies to plan years beginning on or after Jan. 1, 2015. For the 2014 plan year, compliance is based on the proposed rule from 2013, which states that group health plans (including grandfathered, non-grandfathered and self-funded plans) and group health insurance coverage issuers cannot apply a waiting period that exceeds 90 days.

The final rule maintains that eligibility conditions that are not based solely on the passage of time are generally acceptable unless designed to avoid compliance with the 90-day waiting period limitation.

  • If a group health plan conditions eligibility for health care on an employee regularly working a specified number of hours per period (or working full time), and it cannot be determined that a newly hired employee is reasonably expected to meet the required number of hours (or work full time), the health plan may take a reasonable period of time to determine whether the employee meets the plan’s eligibility conditions. A time period designed to determine whether such an employee meets the plan’s eligibility conditions is considered compliant with the 90-day waiting period limitation if coverage is made effective no later than 13 months from the employee’s start date plus, if the employee’s start date is not the first day of a calendar month, the time remaining until the first day of the next calendar month.

Health insurance issuers may rely on the eligibility information reported by employers (or other plan sponsors) and will not be considered in violation of the 90-day waiting period limitation if:

  • Issuers require plan sponsors to make a representation regarding the terms of any eligibility conditions or waiting periods imposed by plan sponsors before an individual is eligible to become covered under the terms of the plan (and requires plan sponsors to update this representation with any applicable changes); and
  • Issuers have no specific knowledge of the imposition of a waiting period that would exceed the permitted 90-day period.

All calendar days are counted beginning on the eligibility date, including weekends and holidays. Employee coverage must begin on or before the 91st day of eligibility.

Proposed rule on waiting periods and orientation periods
The proposed rule on orientation periods may be relied on for the 2014 plan year.

The proposed rule, issued in conjunction with the final 90-day waiting period rule, allows for a “reasonable and bona fide” employment-based orientation period of no more than one month.

During this time the employer and employee can evaluate whether the employment situation is satisfactory, and standard orientation and training processes begin.

The Proposed Rule may be relied on throughout 2014 and if a final rule is more restrictive, reasonable time for compliance will be provided.

More information can be found at:

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*Blue Cross Blue Shield of Michigan is not responsible for the content or practices of the destination website.
The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

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Reform-Alert-Header

On Nov. 25, 2013, the Department of Health and Human Services (HHS) issued guidance proposing changes to the annual open enrollment period and the qualified health plan (QHP) certification deadlines for the 2015 benefit year.

For the 2015 benefit year, the proposed annual open enrollment period is Nov. 15, 2014 through Jan. 15, 2015:

Enroll by Dec. 15, 2014
For Coverage Effective January 1, 2015

Enroll December 16, 2014 through January 15, 2015
For Coverage Effective February 1, 2015

Qualified individuals already enrolled in a QHP through the Marketplace in 2014 who maintain the same eligibility would have their coverage continue into 2015, but may choose to select new coverage at any time during the annual open enrollment period.

The annual open enrollment period for benefit years on or after 2016 is still Oct. 15 through Dec. 7 of the preceding calendar year, with coverage effective the first day of the following benefit year.

If finalized, the Marketplace is expected to delay 2015 QHP certification dates by at least one month.

HHS is currently seeking comments.

Where can I find more information?

Blue Cross Blue Shield of Michigan will continue to monitor and advise when new information is received. Please visit our Reform Alerts webpage for the latest health care reform updates.

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an
educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

Reform-Alert-Header

The Department of Health and Human Services (HHS) advised Friday, Nov. 22, 2013, individuals will have an extra week to enroll in coverage effective Jan. 1, 2014. The delay is to account for technical issues experienced with the healthcare.gov website. The original Dec. 15 deadline for people to apply for coverage effective Jan. 1 has been extended to Dec. 23.

The President’s announcement came in response to concerns expressed by individuals and groups who had received notification that their current plan would be discontinued because it was not compliant with Affordable Care Act requirements.

The delay does not change the 2014 open enrollment period which began Oct. 1, 2013, and runs through March 31, 2014.

For 2015 coverage, HHS announced applicants can sign up starting Nov. 15, 2014, rather than Oct. 15, 2014, and have until Jan. 15, 2015, rather than Dec. 7, 2014, to complete the process.

The extension will allow the federally run Marketplace more time to prepare for the next open enrollment period and allow insurers to make appropriate rate decisions.

Where can I find more information?

More information can be found at healthcare.gov.*

*Blue Cross Blue Shield of Michigan is not responsible for the content or practices of the destination website.

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

Health Care Questions

To help finance health care reform initiatives created under the Affordable Care Act, the federal government established new taxes and fees that impact health insurers and customers. The Blues are committed to helping customers understand what the taxes and fees are for and what they will cost.

Regardless of the customer’s renewal or plan date, the Blues will begin billing fully insured customers for five ACA taxes and fees starting with Jan. 1, 2014 invoices.

Self-funded customers are responsible for calculating and sending ACA tax and fee payments to the federal government. However, we will bill self-funded group customers that purchase stop-loss coverage from Blue Cross for the Federal Insurance Premium Tax. The tax will be assessed on the stop-loss coverage only.

Note: Not all federal and state taxes apply to all segments. We will bill customers for the applicable taxes and fees.

Federal-Taxes-and-Fees-Table

State taxes

There are also two state taxes, the Michigan Claims Tax Assessment and the State Insurance Premium Tax. The Michigan Claims Tax Assessment became effective on Jan. 1, 2012. The Blues will continue to bill fully insured and self-funded groups as well as individuals for this assessment.

The State Insurance Premium Tax will become effective on Jan. 1, 2014. The Blues, like many other health plans, are subject to the State Insurance Premium Tax in lieu of the corporate income tax. The State Insurance Premium Tax does not apply to Blue Care Network plans or self-funded customers.

However, we will bill self-funded group customers that purchase stop-loss coverage from Blue Cross for the State Insurance Premium Tax. The tax will be assessed on the stop-loss coverage only for self-funded customers.

Online tax estimator
Your 2014 quotes, renewals and bills will include the amount of federal and state taxes you will need to pay. If you want a detailed breakdown of your taxes and fees, use our taxes and fees estimator tool at bcbsm.com. It now includes the State Insurance Premium Tax and the ACA federal taxes and fees. (The tool previously only estimated the Michigan Claims Tax Assessment.)

The estimator tool breaks down the taxes presented on the quote, renewal or bill and provides estimated amounts for each tax. It’s important to note that the tool provides estimates, not actual amounts of taxes and fees. And, it does not apply to Medicare Advantage individual and group customers.

To access the tool:

  1. Go to bcbsm.com.
  2. Go to Help and click on Calculators and Tools.
  3. Under Health care reform, click on Health Insurance Tax Estimator.

BCBS-Pantone-Blue

Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.

The Program Integrity: Marketplace, SHOP, Premium Stabilization Programs and Market Standards proposed rule released on June 14 amends two provisions regarding Individual Marketplace eligibility.

  • Incomplete Applications. The proposed rule recognizes there will be applicants who submit incomplete applications. The Marketplace will notify the applicant of missing information needed to make an eligibility determination. The Marketplace will determine a time period, at least 15 days but no more than 90 days, for applicants to provide that missing information.
  • Verification of Minimum Essential Coverage. The proposed rule makes largely technical corrections, and also adds a new paragraph enabling HHS to provide a response to the Marketplace in order to verify information about eligibility and verify enrollment in minimum essential coverage public programs other than Medicaid, Children’s Medicaid (CHIP) and the Basic Health Programs — such as the Veterans Health Administration, TRICARE and Medicare.

Where can I find more information?
More information can be found in the proposed rule (PDF).*

BCBS-Pantone-Blue

*Blue Cross Blue Shield of Michigan is not responsible for the content or practices of the destination website.

 

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an
educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

The Affordable Care Act (ACA) requires the Center for Medicare and Medicaid Services (CMS) to develop and provide to each state a single, streamlined application for (Small Business Health Options) SHOP enrollment. Alternatively, states may elect to develop and use their own application, subject to approval by CMS, but Michigan is currently not developing its own applications. Draft applications for employers and employees, including logic for the online applications, were initially proposed in January 2013.

On May 31, 2013, CMS released revised paper applications for employers and employees. Many of the changes to the paper application were clarifications in the directions, including the addition of a section to help employers determine if their business may be eligible. CMS also strengthened the language regarding providing false information on the application and provided employees with the opportunity to opt out of dental coverage. You can view the revised applications by following the links provided below.

The SHOP also changed the follow-up deadline and now anticipates following up within one to two weeks of application submission, instead of three to four weeks. CMS does not promise to make a decision on eligibility within that timeframe, but states that employers and their employees will get information about the next steps to complete for health coverage through the SHOP.

Employers and their employees will be able to submit an application for the SHOP online, using a paper application, over the phone through an agent or broker, or in person through an agent, broker, or navigator. In most cases, CMS expects that small employers will be able to receive a real-time eligibility determination when applying online. Coverage effective dates may be earlier for applications filed online than for those filed on paper.

Where can I find more information?
Revised applications can be found here: Application for Employers and Application for Employees.*

*Blue Cross Blue Shield of Michigan is not responsible for the content or practices of the destination website.

BCBS-Pantone-Blue

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law’s applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

Health Care Questions

Health care is evolving and there’s a lot of information to wade through. So we’re here to help you get to the bottom line.

How does health care reform impact you and your employees?

We want you to know your options so you can make good decisions about your company’s health care coverage. We’ve started a series that provides you with easy-to-understand information about the Affordable Care Act and its requirements.

So be sure to look for the health care reform articles in each issue. In this article, we begin with the basics.

Why health care reform and why now?

Health care reform is driven by a number of factors:

  • Currently, we spend more than 17 percent of every earned dollar on health care.
  • Almost half of all Americans have chronic diseases — diabetes, asthma, heart and cardiovascular disease — that currently cause about 70 percent of all U.S. deaths.
  • Many people are not insured or don’t have as much insurance as they need.

These are huge issues. Congress passed the health care reform law as the first step in addressing them.

The Patient Protection and Affordable Care Act was signed into law on March 23, 2010. The companion bill, the Health Care and Education Reconciliation Act, was signed on March 30, 2010. Together, these two bills constitute the national health care reform law, known as the Affordable Care Act.

Beginning in 2014, U.S. citizens and legal residents will be required to have health insurance — whether they purchase it on their own, get it through an employer or are covered by a government program such as Medicaid or Medicare. The law requires everyone to have a standard set of basic medical benefits covered in his or her plans. The Affordable Care Act also introduces the Health Insurance Marketplace.

What is the Health Insurance Marketplace?

Starting on Oct. 1, 2013, eligible individuals may buy health insurance through the federal Health Insurance Marketplace. If your employees do not get insurance through your business, their parents or a government-sponsored program, the Marketplace is where they can go to buy insurance if they meet the eligibility requirements.

Think of Expedia.com, where you can compare potential purchases in one place. The Marketplace is meant to give people a place to compare and understand health plans from different companies so that individuals can choose the plan that’s best for them. The Marketplace will also be available by phone and, in certain areas, walk-in centers for people who do not have Internet access.

Preparing your business and your employees

In upcoming issues, we’ll talk about your role in complying with the law — the decisions you need to make and the notices you need to provide your employees. We’ve also created a resource for you and your employees at healthcarereformbasics.com.

This article was provided courtesy of

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