Tuesday, December 11, 2012

Transitional Reinsurance Fee is Making Headlines

It appears that the major media outlets have gotten wind of the recently clarified "Transitional Reinsurance Fees". Several stories are popping up on major media outlets across the country. The requirement imposes a $5.25 per member per month fee ($63 per year) to offset some of the risk that the carriers in the exchanges will be facing in the first three years.

Insurers will pay the fee on their insured business and TPA's can pay the fee on behalf of self-funded employers. For 2014 the payment will be due no later than mid-January 2015.

Click here for a article from CBS News.

Thursday, November 22, 2012

Administration Releases New Health Law Rules For Insurers, Employers


From: Kaiser Health News

Long-awaited details on how insurers can structure health benefits and premiums for policies that will cover tens of millions of Americans starting in 2014 were released by the Obama administration Tuesday.


The three proposed rules reaffirm key elements of the 2010 federal health law, including its requirement that insurers accept all applicants, even those with health conditions, and not charge higher rates based on health, gender or occupation.

But the proposals add additional details on how premiums can vary based on age and tobacco use, including allowing tobacco users who enroll in programs aimed at helping them quit to be exempted from extra premium costs set out in the law.

While insurers and consumer groups were cautious about issuing an immediate assessment of the proposals, a quick review showed that no one group won everything it wanted. For example, insurers did not succeed in getting the government to phase-in a requirement that limits their ability to charge older applicants more than younger ones. And consumer groups, which wanted specific details on the benefits required in 10 broad categories, instead saw continued discretion given to state regulators to pick "benchmark" plans and benefits.

More On The New Rules

Obama Administration Gives Smokers A Way Out Of Higher Insurance Premiums

"It looks like the Obama administration is continuing to be pragmatic in their approach to the regulations," said Robert Laszewski, a consultant and former health insurance executive.

Insurers, consumer groups and the public have 30 days to weigh in with comments on two of the proposed rules and will have until Jan. 25 for the third, which outlines how employers can structure wellness programs that offer discounts to workers who participate.

Based on documents posted on HealthCare.gov, here’s a quick look at the new regulations:

Essential Health Benefits

Insurance plans sold to individuals who buy their own coverage and to employers – except those that self-insure -- must include a core package of items and services known as “essential health benefits.” The benefits are required to cover 10 categories, among them emergency services, hospitalization and pediatric services, including oral and vision care.

The proposed rules reaffirm earlier directions from the administration that states can choose the exact package of benefits that insurers must provide, based largely on what is already offered in the most popular plans currently sold in their states.

Insurers and state regulators wanted states to have that leeway, but consumer groups wanted more prescriptive details.

"Ultimately, the goal is to establish a clear package of essential benefits," said Stephen Finan, senior director of policy American Cancer Society/Cancer Action Network. "Patients should have same set of evidence-based benefits no matter where they live."

But his group and other consumer advocates are cautiously optimistic about one of the changes in the proposed rules, a move that may expand earlier guidance from the administration on prescription drug coverage. That information, released in a bulletin last December, would have set a minimum standard of only one drug per category in a policy's "formulary." The consumer groups feared such a rule would have led to only one type of drug being covered for large categories of problems, such as depression or asthma or cancer.

The new proposed rule says that the minimum standard should be the number of drugs per category in the state’s chosen benchmark plan or one drug, whichever is greater.

Most of the plans being chosen as benchmarks by the states cover more than one drug per category, so the proposed rule sets “a significantly higher standard” that insurers will have to meet, said Caroline Pearson, a director at Avalere Health, a consulting group in Washington.

"It really ensures robust coverage, but you will have state-to-state variation," Pearson said.

Premiums And Other Cost Issues

Insurers can vary their rates based on age, tobacco use and where an applicant lives, but they cannot charge sick people higher rates than the healthy or charge women more than men.

The proposed rules say that insurers can charge tobacco users 50 percent more than non-users, but offers an exemption to those who try to quit.

They also offer more definition of how insurers can increase rates as a person ages. The health law says older people cannot be charged more than three times what younger people are charged. In most states, this could result in lower rates for older residents than under current practices but higher rates for younger people.

The new rules say premium rates cannot vary by age for individuals under age 21.

But, above that age, insurers could charge slightly more for each birthday until a person hits age 63. Everyone over 63 would pay the same rate. The proposal differs from the most common way insurers now set such "age bands," which are generally in five or 10-year increments.

Karen Ignagni, the head of the industry's trade group, said the proposed rules need to insure that health coverage remains affordable. While welcoming the state flexibility, she said, "We remain concerned that many families and small businesses will be required to purchase coverage that is more costly than they have today. It also is important to recognize that the new EHB requirements will coincide with the new restrictions in age rating rules that also go into effect on January 1, 2014. Both of these provisions may incentivize young, healthy people to wait to purchase insurance until they are sick or injured, driving up costs for everyone with insurance."

The proposal also gives more flexibility to states and insurers to vary annual deductibles, co-pays and other elements of the policies -- so long as the policies’ overall coverage meets a requirement known as minimum actuarial value, or the average percentage the plan pays toward a typical consumer’s estimated annual medical costs.

Wellness Programs

The health law allows employers to provide discounts on health insurance to workers who achieve certain medical or fitness goals, including such things as weight, cholesterol level or blood pressure.

The proposed rule raises the maximum permissible reward, discount or penalty from 20 percent to 30 percent of the cost of the health coverage, and further increases the maximum reward to 50 percent for programs to reduce tobacco use.

But the proposed rules also say the programs must offer alternatives for employees whose health conditions make it "unreasonably difficult" or for whom "it is medically inadvisable" to meet the specified health-related standard.

In addition, the discounts or other rewards must be available to workers annually.

While Tuesday’s announcement was significant, the administration still has yet to issue regulations on other parts of the health law. Those areas include how new taxes on premiums and medical devices will work, and how the federal government will set up insurance markets in states that refuse to do it on their own.

The administration also has to determine how to handle the Supreme Court's decision that states can opt out of the expanded Medicaid program created by the law, and how the government will allot a reduced amount of money targeted for hospitals that care for uninsured people. Also outstanding is a final rule on how birth-control coverage will be provided to employees of religious universities and hospitals that object to it.

Staff writers Jordan Rau and Phil Galewitz contributed to this article.

To link to the original article click here.

To link to the guidance on Essential Health Benefits click here.
  To link to the guidance on Wellness Programs click here.

Tuesday, November 13, 2012

States Given Extra Month for Health Exchange Blueprints

Bloomberg

President Barack Obama’s administration gave U.S. states one more month to decide how they plan to develop new health exchanges that will let people shop for insurance coverage.
While the states still must say by Nov. 16 if they plan to build their own marketplaces, they can now wait until Dec. 14 to submit the actual blueprint, Health and Human Services Secretary Kathleen Sebelius said in a letter sent yesterday to state governors. States that want to create a partnership with the federal government to manage the exchanges have until Feb. 15 to outline the duties they’ll handle.

All but 13 governors had taken a wait-and-see approach on the exchanges, which are supposed to be running by 2014 as one of the requirements in Obama’s overhaul of the health-care system. Governors who miss the deadline will turn over to the federal government most authority to decide which insurers can sell plans to their state residents.

“The administration is committed to providing significant flexibility for building a marketplace that best meets your state’s needs,” Sebelius said in the letter.

Thirty-four states have accepted at least two grants from the federal government to start planning an exchange, according to Sebelius’s department. That puts about 20 states in a position to build an exchange or partner with the federal government on one, in addition to the 13, plus the District of Columbia, who have already said they’ll run their own.

The federal exchange will also control enrollment of low- income people into state Medicaid programs.

To link to the Bloomberg artcile click here



Federal government to run Missouri’s health insurance exchange

Samantha Liss
Reporter- St. Louis Business Journal

The federal government will run a health insurance exchange in Missouri.

The state of Missouri will not run an online state-based insurance exchange that is supposed to go live in 2014, St. Louis Public Radio reports.

On Tuesday, voters approved Proposition E, which limits the governor from setting up an exchange by requiring legislature approval. Without approval, Gov. Jay Nixon announced he will tell the federal government Missouri will not set up its own exchange. Nov. 16 is the deadline for states to report to the feds how they'll run the exchange.

Unlike Missouri, Illinois is one step closer to setting up a state-based health insurance exchange, a provision of the 2010 Affordable Care Act (ACA), which will allow small businesses and individuals to purchase health insurance and compare prices online. Crain’s reports that the state of Illinois is reviewing five bids to set up the exchange.

To link directly to the article click here


Wednesday, November 7, 2012

Obama victory secures health care reform law, but questions remain


Jerry Giesel

President Barack Obama's re-election Tuesday night assures continued implementation of the health care reform law, but many details remain unresolved.


And President Obama's defeat of Republican challenger Mitt Romney, who had pledged to repeal the Patient Protection and Affordable Care Act, won't end continued legal challenges to the law.The most immediate impact of President Obama's re-election, observers say, will be a speedup of health care reform law regulations that employers will need to comply with the law.There will be an avalanche of regulations,” said Gretchen Young, senior vice president-health policy with the ERISA Industry Committee in Washington.“They (regulators) have to get it done. It is crucial,” said Chantel Sheaks, a principal with Buck Consultants L.L.C. in Washington.

Penalty questions

For example, employers have been waiting for more than a year and a half for the U.S. Department of the Treasury to release guidance on a reform law provision of critical importance to nearly every company: the imposition of a stiff $2,000-per-full-time-employee penalty on employers that do not offer qualified coverage to employees. Read literally, the law says the penalty applies even if just one full-time employee is not offered coverage. Last year, the Treasury Department said it “contemplated” in forthcoming regulations to make clear that the penalty would not apply if an employer offered coverage to “substantially” all full-time employees.But 18 months later, employers still are waiting for that guidance.Many other health care reform provisions have yet to be fully addressed.

For example, employers are waiting for Treasury to make clear if a provision that imposes a penalty if coverage is not “affordable” applies to individual and family coverage. Earlier, Treasury Department guidance said if the share of the premium paid by an employee for family coverage was at least 9.5% of his or her income and the employee was eligible for and used a reform law subsidy to buy coverage in a public health insurance exchange, the employer would be liable for a $3,000 penalty for that employee. Earlier this year, however, the Treasury Department said it was reconsidering that earlier rule to examine whether the premium should also apply if the premium for individual coverage was not affordable.
Transitional reinsurance program
In addition, employers are waiting for the U.S. Department of Health and Human Services to inform them how much they will have to pay to fund a $25 billion three-year federal reinsurance program that will partially reimburse commercial insurers writing coverage for individuals with high health care costs. Consultants estimate that the assessment for the Transitional Reinsurance Program will be between $60 to $90 per health care plan participant, which would mean that large employers would face millions of dollars in new assessments for a three-year period starting in 2014.Aside from not knowing how much they will have to pay, regulators need to clarify many aspects of the reinsurance program, such as whether the assessment applies to participants in retiree health care plans.“We really need guidance,” Ms. Young said.

Legal challenges

And there is plenty of uncertainty on the legal front. Dozens of organizations have challenged a health care reform law regulation that will require employers, including nonprofit affiliates such as hospitals and universities of religious organizations, to extend coverage for prescription contraceptives.In addition, a suit over premium subsidies, if successful, could stymie the main intent of the health care reform law — a big reduction in the 50 million people in the United States who are uninsured.That suit, filed by Oklahoma Attorney General Scott Pruitt, challenges the legality of Internal Revenue Service regulations that say premium subsidies can be provided to eligible individuals who obtain coverage in exchanges set by the states and the federal government.The Oklahoma suit says the health care reform law makes it clear that the subsidies are available for coverage for exchanges only set up by the states. Since many states — perhaps close to half — may decide against setting up exchanges, millions of people in states where the federal government sets up exchanges because the states don't, would not be eligible for premium subsidies. “Court challenges will continue to be a thorn in the side of the administration,” Ms. Sheaks said.How federal lawmakers tinker with the law is another unknown. But with President Obama's victory Tuesday night and the Democrats retaining control of the Senate, Republicans are likely during the next congressional session to move away from trying to repeal the reform law. “There is no way the law is going to be repealed in the next two years, and Republicans know that,” Ms. Sheaks said.As a result, Republicans will be more likely in 2013 to work with Democrats on making changes to the law, including technical corrections and those that have widespread support, Ms. Sheaks said.


To view the original article click here


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Monday, October 15, 2012

Guidance on health reform law's Transitional Reinsurance Program requested

The American Benefits Council is asking federal regulators for guidance on the Transitional Reinsurance Program, an obscure but costly health care reform law-created program that will require self-funded employers to pay billions of dollars that will partially reimburse commercial insurers writing policies for individuals with very high health care costs.

The first-year assessment for the three-year program, which begins in 2014, is expected to be in a range of $60 to $90 per health care plan participant. If the upper end of that estimate proves accurate, the first-year tab for an employer with 100,000 health care plan participants could be nearly $10 million.


Many questions remain unanswered about the Transitional Reinsurance Program, the Washington-based benefits lobbying group noted in a letter sent this month to the U.S. Department of Health and Human Services, which will enforce the program.
Some of those issues include:
• Does the fee apply to retiree health-only plans? ABC said such plans should be excluded “in light of the strong public policy reasons for encouraging employers to sponsor retiree-only plans and other plans for former employees.”


• Should COBRA beneficiaries be included in calculating the fee? “Additional guidance would be helpful to clarify whether the fee is intended to be assessed on persons receiving coverage as a result of coverage,” according to the ABC letter, which was co-signed by Paul Dennett, senior vice president-health care reform and Kathryn Wilber, senior counsel-health policy.


• Is the fee tax-deductible? “We recommend that HHS work with Treasury and the Internal Revenue Service to issue guidance affirming that the fee is deductible in order to eliminate any uncertainty on this matter,” Mr. Dennett and Ms. Wilber wrote in their letter.

To view the original article click here.

Monday, September 10, 2012

Romney says certain PPACA provisions should remain

GOP presidential candidate Mitt Romney says that while he would seek to repeal the health care reform law if he were elected, he could keep at least two politically popular provisions.


“I’m not getting rid of all of health care reform. Of course, there are a number of things that I like in health care reform that I’m going to put in place,” Mr. Romney said during NBC’s “Meet the Press” on Sunday. Specifically, Mr. Romney said he would continue the Patient Protection and Affordable Care Act provision that bans health care plans from denying coverage of pre-existing medical conditions.In addition, Mr. Romney said he supports continuing and perhaps even expanding a provision that requires health care plans to provide coverage of employees’ adult children up to age 26.Mr. Romney said he would want “to assure that the marketplace allows for individuals to have policies that cover their family up to whatever age they might be.

To view the entire article click here





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Tuesday, September 4, 2012

Safe Harbor for Determining Full Time Employees for PPACA

Many employers have been questioning what the "look back" period will be for determining who is considered a full time employee and therefore must be offered coverage under the PPACA legislaton. On Friday, August 31st the IRS issued guidance on this topic. Click here to see the guidance in full.

Below is an excerpt from the guidance defining the safe harbor for determining full time status for "ongoing" employees:

An “ongoing employee” is generally an employee who has been employed by the

employer for at least one complete standard measurement period. As stated in Notice
2011-36, different rules may apply to employees who move into full-time status during
the year. Additional rules regarding the treatment of employees who experience a
change in employment status are expected to be included in upcoming regulations.

Under the safe harbor method for ongoing employees, an employer determines
each ongoing employee’s full-time status by looking back at the standard measurement
period (a defined time period of not less than three but not more than 12 consecutive
calendar months, as chosen by the employer). The employer has the flexibility to
determine the months in which the standard measurement period starts and ends,
provided that the determination must be made on a uniform and consistent basis for all
employees in the same category. (See below in this section for permissible categories.)

For example, if an employer chose a standard measurement period of 12 months, the
employer could choose to make it the calendar year, a non-calendar plan year, or a
different 12-month period, such as one that ends shortly before the start of the plan’s
annual open enrollment season. If the employer determines that an employee
averaged at least 30 hours per week during the standard measurement period, then the
employer treats the employee as a full-time employee during a subsequent “stability
period”, regardless of the employee’s number of hours of service during the stability
period, so long as he or she remained an employee.

For an employee whom the employer determines to be a full-time employee
during the standard measurement period, the stability period would be a period of at
least six consecutive calendar months that is no shorter in duration than the standard
measurement period and that begins after the standard measurement period (and any
applicable administrative period, as discussed in section III.B, below). If the employer
determines that the employee did not work full-time during the standard measurement
period, the employer would be permitted to treat the employee as not a full-time
employee during the stability period that follows, but is not longer than, the standard
measurement period.

Click here to see the guidance in full.








Friday, August 31, 2012

The Health Care Reform Provision You Haven't Heard About

Ask any employer how health care reform affects them and you'll most likely hear items such as play-or-pay or automatic enrollment, and you may even hear comparative effectiveness research fee. I bet you will not hear: health insurance provider premium tax. Makes sense, though. Providers will be responsible for paying this tax. So, why should you care about it (especially if you offer fully insured medical plans)? Here’s why:


Beginning in 2014, Section 9010 of the Patient Protection and Affordable Care Act will impose a new tax on health insurance providers. The tax is $8 billion in 2014, $11.3 billion in 2015 and 2016, $13.9 billion in 2017 and $14.3 billion in 2018. The tax will continue beyond 2018 but future amounts have not been provided yet. Many providers will be affected and each provider’s tax will depend on their net premiums written during the calendar year.


To read the entire article by Ed Bray, J.D. click here

Wednesday, August 29, 2012

GOP Platform "Committed" to Repeal of PPACA

If Mitt Romney is elected president and Republicans win control of the Senate and retain their majority in the House of Representatives, that will “guarantee” that the 2010 health care reform law is never fully implemented, according to the party platform adopted Tuesday by delegates at the GOP convention in Tampa.
“Congressional Republicans are committed to its repeal; and a Republican president on the first day in office will use his legitimate waiver authority under that law to halt its progress and then will sign its repeal,” the platform says.The platform describes the Patient Protection and Affordable Care Act as the “high-water mark of an outdated liberalism, the latest attempt to impose upon Americans a euro-style bureaucracy to manage all aspects of our lives.”The health care reform law, the platform says, “is falling by the weight of its own confusing, unworkable, budget-busting and conflicting provisions.”The platform also says Republicans will push to “empower” individuals and small business to form health care purchasing pools as well as to eliminate any federal subsidies on health care plans that provide coverage for abortion. Under current law, a self-funded employer, for example, can take a tax deduction for abortion-related expenses its health care plan covers.

To view the full article click here

Thursday, July 26, 2012

Supreme Court Medicaid ruling to leave 36 million uninsured in 2016: CBO

WASHINGTON—Congressional analysts have increased their estimate of the number of uninsured U.S. residents in the wake of the U.S. Supreme Court striking down a health care reform law provision that would have financially punished states if they did not expand Medicaid eligibility.
In March, the Congressional Budget Office estimated that in 2016—two years after several key provisions of the reform law go into effect—that 32 million U.S. residents would be uninsured, down from the current estimate of 53 million.
But in an analysis released Tuesday, CBO now estimates that 36 million U.S. residents will be uninsured in 2016.
The revised estimate is due to last month's Supreme Court decision that struck down a reform law provision in which states would have lost all federal Medicaid funding if they did not boost the maximum income residents could earn and still be eligible for Medicaid coverage.
CBO said it now anticipates “that some states will not expand their programs at all or will not expand coverage to the full extent authorized” by the Patient Protection an Affordable Care Act.
A smaller reduction in the number of uninsured could negatively affect employers as the amount of uncompensated care—a cost that health care providers now try to shift in the form of higher charges to patients with health insurance—will not decline as much as providers had initially hoped.

To view the original article click here.



Friday, July 13, 2012

Feds to waive insurance mandate for low-income people in states that don’t expand Medicaid

By Associated Press, Published: July 10


WASHINGTON — The Obama administration says low-income residents in states that decide to opt out of a big Medicaid expansion in the new health care law will not risk federal penalties as an unintended consequence.


The Supreme Court upheld most of President Barack Obama’s health care law last week, including its requirement that virtually all Americans carry medical insurance. But the court gave states the option of saying no to a Medicaid expansion expected to provide coverage to more than 15 million people, mainly childless adults. Officials in some Republican-led states are already saying they’ll opt out.


In a letter to governors Tuesday, Health and Human Services Secretary Kathleen Sebelius said low-income residents in those states who would have been eligible for the coverage will not face the individual insurance mandate.



Wednesday, July 11, 2012

House Passes Refrom Repeal

CBS News) The Republican-led effort to repeal President Obama's health care law passed the House of Representatives Wednesday, successfully setting up campaign talking points for the coming months, but accomplishing little else.

The vote was the 33rd time the House has voted to repeal all or part of the Affordable Care Act, but Wednesday's vote was the first House action to repeal since the Supreme Court upheld the constitutionality of the law nearly two weeks ago.

With the reality that it will also be the 33rd time that the measure will fail to be passed by the Democratic-led Senate, Wednesday's action ultimately winds up being only political in nature, giving Republicans material for their political races to tell voters that they are committed to sinking the health care overhaul.

We are voting "so we may all be on record in order to show that the house rejects 'Obamacare,' and we are committed to taking this flawed law off the books," House Majority Leader Eric Cantor, R-Va., sad on the House floor.

The vote, 244 - 185, was largely along party lines but five Democrats sided with the entire Republican caucus.

House Democrats, bolstered by the Supreme Court's decision last month, called the vote pure politics.

This is a "useless bill to nowhere that does serious damage to the health and well being of American families," said House Minority Leader Nancy Pelosi, D-Calif.

White House spokesperson Jay Carney added the vote is what people "loathe about politics and Washington."

House Speaker John Boehner, R-Ohio, said the House voted because Americans "certainly didn't ask for a government takeover" of health care. "There is a better way. Americans want a step by step approach," he said on the House floor prior to the vote.

Republican presidential candidate Mitt Romney has repeatedly promised to "repeal and replace" the law if elected.
Since the Supreme Court upheld the law last month, the president has touted the ruling on the campaign trail. In Cedar Rapids, Iowa, Tuesday, the president said he will "work with anybody to improve the health care law where we can, but this law is here to stay."



Obama Vows to Veto Legislation to Repeal Reform

WASHINGTON—If a health care reform repeal bill—to be voted on by the House of Representatives on Wednesday—receives final congressional approval, President Barack Obama would veto it, the administration said.
Repeal of the Patient Protection and Affordable Care Act would result in more than 250 million U.S. residents losing the benefits and protections they receive under the law, the administration said Monday in a statement.Among other things, older adult children would lose coverage—a reform law provision that requires group plans to extend coverage to employees' children up to age 26. In addition, group plans could impose annual and lifetime dollar limits on coverage, while 30 million uninsured residents would lose coverage they expect to receive in 2014 when federal premium subsidies to the uninsured and expanded Medicaid eligibility take effect, the administration said.It is unlikely, though, that President Obama will have an opportunity to veto H.R. 6079, which House Majority Leader Eric Cantor, R-Va., introduced Monday.While the House is expected to approve the measure, Repeal of Obamacare Act, the bill has little chance of winning approval in the Senate, where Democrats are in the majority.


To view the original article click here


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Thursday, June 28, 2012

Surpreme Court Upholds Reform, But Verdict May Hold Surprises

THURSDAY, June 28 (HealthDay News) -- After the U.S. Supreme Court's announcement Thursday that it would uphold most of the 2010 Affordable Care Act, many legal experts were quick to register their surprise at the decision -- and their sense that perhaps the battle over health-care reform was not yet finished.
The complicated 5-to-4 decision allows the law to proceed with its goal of covering more than 30 million uninsured Americans. That includes the controversial "individual mandate" provision, which requires most consumers to buy health care insurance or face a penalty. The court held that the mandate fell under the category of a tax, and as such was constitutional and could stand.
That came as a surprise to Stephen Presser, a professor of legal history at Northwestern University School of Law in Chicago. He had predicted that the Supreme Court would find the health-reform law unconstitutional and the whole package would go down.
"I had thought that the issue of whether [the individual mandate] was a tax was over and done with," Presser said. "This strikes me as a disappointing decision, which fails fully to preserve the limitations on the Constitution of the federal government," he added.
"It's disappointing that all the proponents of the Act had steadfastly said that this was not a tax. That this was not a bill to raise revenues, that this was not a bill to increase health care costs. Had it acknowledged that it was in fact a tax, it's much more doubtful that it would have passed, given the thin margin that it did pass by, it may have made a difference. So what the court has done is salvaged the Act in a Constitutional sleight of hand," Presser said.
But Renee Landers, a professor of law at Suffolk University Law School, had betted on the other side -- that the mandate could still survive -- and today's decision justified her confidence.
"It was hard to stay with that opinion the last few weeks though because everybody was so busy hedging their bets," she said. She was somewhat surprised at one of the four dissenters: "I thought [Justice Anthony] Kennedy would go over for it, but he didn't."
However, she wasn't surprised that Chief Justice John Roberts backed the majority decision.
"I think at the end that Roberts was motivated by that overturning an act of Congress is a really significant action by the court even though not [entirely] unprecedented, and if at all possible the court should work to uphold the Constitution," Landers said.
The decision did limit the expansion of Medicaid as proposed under the law.
"What they said was that the part of the expansion that would penalize states -- that would withdraw all Medicaid funding from the states if they didn't go along with the expansion -- is invalid," Landers explained. "The expansion still exists, but a state can either sign onto it or not and won't lose all its current Medicaid funding if it doesn't go along with the expansion."
While some states are already expanding their Medicaid roles and others are happy to cooperate because of the federal funding they'll receive, she said, "there are always those states who are very parsimonious -- not generous -- in granting Medicaid benefits to adults. So basically, this decision will have the effect of limiting the impact of the law in getting more adults insurance coverage."
Another expert, Robert Field, a professor of law in the department of health management and policy at Drexel University's School of Public Health, weighed in and found that each side may have gained from the decision.
"I do think this is potentially a win for both sides, although the losers in the case may not immediately see it this way," Field added. "I think [President Barack] Obama wins politically. He gets around the charge that [Republican Mitt] Romney had been making that he wasted all his political capital on something that was unconstitutional."
And for conservatives, "there is no new precedent that expands Congress' power" when it comes to the Medicaid provision, Field added.
"[The Justices are] saying that Congress can expand Medicaid and can offer states a carrot to expand it, but they cannot follow the carrot with a stick that would take away their entire Medicaid programs if they don't agree to the expansion," Field explained. "The carrot is the 90 percent to 100 percent of the expansion that Congress will pay. However, the law had said that if the states don't go along with that they could lose funding for their entire Medicaid program. Now that wouldn't happen. The worse that would happen to them is their programs will stay as they are."
Gregory Magarian, a professor at Washington University School of Law in St. Louis, believed that the entire law would pass by a narrow margin, but on a different basis.
"The result is what I was expecting on the mandate, but the way they got to it is not at all what I was expecting," Magarian said. "It sounds to me that the court was trying to be as cautious as it could in wading into the constitutional issues. What it found was the narrowest way to uphold the mandate and therefore uphold the rest of the Act. I think the result is the right result under my best understanding of the law so I'm very happy with what the court did. But it really is a curveball in terms of how they got there."
So, is this the end of the battle over health care reform? Probably not: the fight may simply switch venues, the experts said.
Today's decision by the Supreme Court settled the constitutionality of the Affordable Care Act, and now "Congress is free to change the provisions of the statute that the Court has said is constitutional," according to Landers.


To view the entire article click here.

Monday, June 11, 2012

Overwhelming Majority of Employees To Continue Health Coverage in 2014

The overwhelming majority of employers say they will continue to offer health care plan coverage to employees in 2014 when key provisions of the health care reform law kick in, according to a survey of benefit professionals.

More than 85% of employers responding to an International Foundation of Employee Benefit Plans survey say they either definitely will or are very likely to continue coverage in 2014, while nearly 10% said they are somewhat likely to continue coverage.Just 1% said they definitely will not offer coverage, while nearly 4% said are somewhat unlikely or very unlikely to offer coverage in 2014.Retaining and attracting employees were the top reasons employers say they will continue coverage in 2014, even though—assuming they dropped their health care plans—federal premium subsidies would be available to their lower- and middle-income employees to buy coverage in state insurance exchanges.

Top reasons cited

When asked to provide their two top reasons for maintaining coverage, just over 55% of respondents said retaining current employees and attracting future talent were the top reasons they will keep their plans and just over 53% said maintaining and/or increasing employee satisfaction and loyalty was the top reason for retaining coverage.“These employers recognize that offering health care coverage is an important benefit that helps retain current employees, attract future talent, and increase employee satisfaction,” Michael Wilson, International Foundation CEO said in a statement.Results are based on the responses of 968 individuals, including benefit and human resource managers, general and financial managers and other professionals.Just over 9% cited retention of tax advantages as a reason for keeping coverage and just over 7% said a top reason for keeping coverage was to avoid tax penalties. Under the Patient Protection and Affordable Care Act, employers will, starting in 2014, be liable for a nontax-deductible $2,000 per full-time employee penalty if they do not offer coverage.

To view the original article click here





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UnitedHealth to Keep Reforms, Whatever Court Decides

By Lewis Krauskopf

(Reuters) - UnitedHealth Group Inc, the largest U.S. health insurer by market value, said it would maintain the health coverage protections included in President Barack Obama's healthcare law regardless of how the Supreme Court rules on the legislation.
 The Supreme Court is expected to decide later this month whether to strike down all or portions of the law, Obama's signature domestic policy achievement that was passed in 2010.

The provisions UnitedHealth will maintain include continuing to provide coverage for dependents up to age 26 under their parents' plan.  The company will also continue to offer certain preventive healthcare services without requiring a co-payment, which include annual check-ups, screening for high-blood pressure and diabetes, and immunizations.

UnitedHealth will also continue to forgo lifetime dollar coverage limits on policies.  "The protections we are voluntarily extending are good for people's health, promote broader access to quality care and contribute to helping control rising health care costs," UnitedHealth Chief Executive Officer Stephen Hemsley said in a statement. "These provisions make sense for the people we serve and it is important to ensure they know these provisions will continue."

The law, known as the Affordable Care Act, represented the biggest overhaul to the $2.6 trillion U.S. healthcare system in nearly 50 years.  UnitedHealth's vow applies to provisions that have already begun, although many of the more sweeping changes in the legislation have yet to take effect.  It is designed to eventually expand coverage to more than 30 million uninsured Americans, by establishing insurance exchanges and broadening the Medicaid program for low-income Americans.

The provision allowing children to stay on their parents' plans up to age 26 is perhaps the single most popular component.  The law likely enabled about 6.6 million young adults to join their parents' health insurance plans last year, according to a recent report from The Commonwealth Fund, a non-profit organization that analyzes healthcare issues.  Should the law be struck down, Republican lawmakers may seek to reinstate the extension of young adults dependent coverage.

The other provisions UnitedHealth will maintain include providing clear ways for members to appeal coverage claim decisions; and the elimination of rescissions, which are generally considered to be retroactive policy cancellations, except in the case of fraud.  DeAnn Friedholm, director for health reform at Consumers Union, called UnitedHealth's actions "a positive step" and said she hoped other companies would follow suit should the law be struck down.

Several other large health insurers did not immediately respond to questions over whether they would also continue to offer the coverage provisions. Cigna Corp said it was "prepared to proceed as appropriate on behalf of our customers when the court deliberations reach their conclusion."

An insurance industry source said that other insurers are likely to keep some of these benefits in their policies if the entire law is overturned.

UnitedHealth, which serves more than 38 million members, said the protections are effective immediately and will be available to current and future plan members. The law also bars insurers from denying coverage to children up to age 19 with pre-existing medical conditions. UnitedHealth said that while it recognized the value of this provision, "One company acting alone cannot take that step, so UnitedHealthcare is committed to working with all other participants in the health care system to sustain that coverage."  The ban on denying coverage to those with pre-existing conditions will apply to adults starting in 2014, under the law.

Friedholm of Consumers Union said if a single company "declared they would take any comers, and their competitors do not, then they will immediately attract the sickest population, which would disadvantage them in trying to compete on prices."

"It requires a level playing field so that all the companies have to play by the same rule," Friedholm said.

In addition to the insurance protections and coverage expansion, the healthcare overhaul law adds new regulations and fees to the healthcare industry, particularly health insurance companies.

Insurers are required to spend a certain level of their premium revenue on medical care and face more stringent reviews of rate increases. At the heart of the Supreme Court case is a requirement in the law that individuals buy health insurance coverage or face a penalty, known as the individual mandate. Should the mandate alone be struck down, and the companies are required to cover people regardless of health status, the insurers have said people will buy insurance only when they become ill, causing premiums to rise.

 
(Reporting by Lewis Krauskopf in New York; Editing by Chris Gallagher and Tim Dobbyn)

To view the original article click here





Friday, June 8, 2012

Despite Veto Threat, House Approves Changes to Use It or Lose It Rule

Defying a presidential veto threat, the House of Representatives on Thursday approved legislation that would ease a 28-year-old Internal Revenue Service rule that requires forfeiture of unused flexible spending account balances and eliminates restrictions on using FSAs and health savings accounts to pay for over-the-counter medications.


Under the measure, approved on a 270-146 vote, employers could amend their FSAs to allow employees to withdraw as taxable cash up to $500 in unused balances remaining at the end of the plan year or at the end of an FSA grace period, if an employer has that feature. In addition, H.R. 436 would overturn a health care reform law provision that bars FSA reimbursement of OTC medications without a prescription and imposes a 20% federal tax on HSA distributions for OTC medications obtained without a prescription.

Senate approval ‘unlikely’


President Barack Obama, though, may not have an opportunity to carry out his veto threat as the Senate may not even take up the proposal, some benefit observers say.“I don’t think the Senate will act,” said J.D. Piro, a senior vp at Aon Hewitt in Norwalk, Conn.Bundling the FSA provisions with the repeal of the excise taxes on medical devices makes the bill’s chances of winning Senate approval “very unlikely,” said Chantel Sheaks, a principal with Buck Consultants L.L.C. in Washington.Giving FSA participants the ability to receive up to $500 of unused balances would have only a modest impact on boosting plan participation and would be somewhat administratively burdensome on employers, Mr. Piro said.


To view the entire story click here

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Thursday, June 7, 2012

Obama to Veto FSA/HSA Legislation

WASHINGTON—President Barack Obama will veto legislation that would ease a 28-year-old Internal Revenue Service rule that requires forfeiture of unused flexible spending account balances and eliminates restrictions on using FSAs and health savings accounts to pay for over-the-counter medications, the administration said Wednesday.


Under the measure headed for a vote this week on the House floor, employers could amend their FSAs to allow employees to withdraw as taxable cash up to $500 in unused balances remaining at the end of the plan year or at the end of an FSA grace period, if an employer has that feature. If passed, the measure would be considered by the Senate.

OTC medications

In addition, H.R. 436 would overturn a health care reform law provision that allows FSA reimbursement of OTC medications without a prescription and imposes a 20% federal tax on HSA distributions for OTC medications obtained without a prescription. Those provisions are part of a broader bill, H.R 436, that would repeal a provision from the Patient Protection and Affordable Care Act that imposes new federal excise taxes on medical devices and boosts repayments of federal premium subsidies provided to low-income and middle-class uninsured individuals in situations in which the subsidies turn out to be higher than the individuals were entitled.It is those provisions that the administration opposes.“This excise tax is one of several designed so that industries that gain from the coverage expansion will help offset the cost of that expansion,” the Office of Management and Budget said in a statement.“In sum, H.R. 436 would fund tax breaks for industry by raising taxes on middle-class and low-income families. Instead of working together to reduce health care costs, H.R. 436 chooses to refight old political battles over health care. If the president were presented with H.R. 436, his senior advisers would recommend that he veto the bill,” OBM said.

To view the original article click here



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Friday, June 1, 2012

Flexible Spending Accounts: Clarifying all the Recent Buzz and Legislation


Recently there has been quite a bit of buzz out of Washington regarding Flexible Spending Accounts (FSA). Two different things have recently taken place: 




#1 - The Internal Revenue Service on Wednesday provided regulatory relief for health care flexible spending account participants and also said it is reconsidering its longtime use-it-or-lose-it rule for FSAs.



Under that relief, the IRS said participants in noncalendar-year plans can still make the maximum contributions to their FSAs during the first year that a mandated FSA contribution cutback goes into effect under the health care reform law.


The issue involves a provision in the Patient Protection and Affordable Care Act, which goes into effect on Jan. 1, 2013. Under that provision, the maximum annual contribution employees can make to their FSAs will be $2,500. Under current law, there is no annual limit, though employers typically limit annual contributions to $4,000 to $5,000


To read a full article about this guidance click here

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# 2 The House Ways and Means Committtee voted on three separate changes to the FSA/HSA legislation that will be explained below. The key things to remember regarding these items is that they haven't yet been heard by the whole House, so they have not been voted into law as of this post.



Use-it-or-lose-it


A decades-old Internal Revenue Service rule that requires forfeiture of unused flexible spending account balances would be eased, and health care reform law-imposed restrictions on using FSAs and health savings accounts to pay for over-the-counter medications would be eliminated, under separate bills approved Thursday by a panel of the U.S. House of Representatives.


Under the Medical FSA Improvement Act of 2011, H.R. 1004, cleared by the House Ways and Means Committee on a 23-6 vote, employers could amend their FSAs to allow employees to withdraw as taxable cash up to $500 in unused balances remaining at the end of the plan year or at the end of an FSA grace period, if an employer has that feature.


The distribution would have to be made no later than seven months after the close of the plan year.
The committee action coincides with an IRS announcement this week that it will consider modifying the 1984 use-it-or-lose-it rule that requires forfeitures of unused FSA balances at the end of a plan year or grace period.


Over-the-counter medications


The other bill—the Restoring Access to Medication Act, H.R. 5842—which the committee approved on a 24-9 vote, would overturn an unpopular provision in the health care reform law that restricts the use of flexible spending accounts and health savings accounts to reimburse employees for OTC medications.
Under that provision, FSA reimbursement is permitted only if the employee obtains a prescription for the medication, while in the case of HSAs, OTC reimbursement is permitted without a prescription but a 20% federal tax is imposed on the distribution.


The bill approved by the House panel would eliminate those OTC restrictions in the health care reform law.

Retiree HSA distributions


A third bill, H.R. 5858, approved by a 21-7 margin, would allow retired employees who are at least age 55 but not yet eligible for Medicare to withdraw funds tax-free from their health savings accounts to pay premiums in early retiree health care plans offered by their former employers.


The three bills are expected to be considered by the full House next week.









Wednesday, May 30, 2012

House to Rule on OTC Restrcitions

WASHINGTON—The House Ways and Means Committee is expected to vote on and pass legislation that would overturn an unpopular provision in the health care reform law that restricts the use of flexible spending accounts and health savings accounts to reimburse employees for over-the-counter medications.


Under that provision, FSA reimbursement is permitted only if the employee obtains a prescription for the medication, while in the case of HSAs, OTC reimbursement is permitted without a prescription, but a 20% federal tax is imposed on the distribution.

The bill, H.R. 5842, to be considered Thursday by the committee, would eliminate the OTC restrictions in the Patient Protection and Affordable Care Act of 2010.

The restrictions are very unpopular among employers. Sixty-two percent of employers responding to a Midwest Business Group on Health survey said they favored repeal of the provision, which made it the second most unpopular health care reform law provision among respondents. The most unpopular was the provision, effective in 2013, that will place a $2,500 annual cap on FSA contributions.

To view the original artcile click here

Tuesday, May 22, 2012

Regulators Provide Additional Guidance on SBC's

Adding additional certainty to previous guidance, federal regulators made clear that they will not impose financial penalties on employers that do not fully comply with health care reform law requirements that will require them to distribute to employees a new summary of benefits and coverage statement.


In February, the Obama administration delayed by six months the requirement to distribute to employees the new summary of benefits and coverage statement.The requirement will go into effect for plan years that begin on or after Sept. 23, 2012. For example, if a plan year begins on Jan. 1, 2013, and the employer's open enrollment period is from Oct. 1 to Nov. 1, the new SBC would have to be available by Oct. 1, 2012.At the time, regulators said they did not “intend” to impose penalties during the first year the requirement is in effect so long as employers are working in “good faith” to comply.In the latest guidance, released as part of frequently asked questions and answers, regulators said during the first year the requirement is in effect agencies “will not impose penalties on plans and issuers that are working diligently and in good faith to comply.”Benefit experts welcome the latest clarification. 

To view the FAQ's click here and here

To view the sample template of the SBC click here



 

Monday, April 30, 2012

HSA Limits Announced for 2013

The IRS has issued the cost of living contribtuion and coverage adjustments for 2013. They are as follows:

2013 Individual Deductible: $3250

2013 Family Deductible:     $6450

2013 Catch Up Contrib:     $1000

2013 Maximum Out-of-Pocket Amounts:  $6250 (ind) / $12,500 (fam)

2013 Minimum Deductible Amounts:         $1250 (ind) / $2500 (fam)

To view the IRS release click here 

Monday, April 23, 2012

IRS Proposed Rule on Comparative Effectivness Fee

Proposed Internal Revenue Service regulations would resolve numerous questions employers and others have raised about a fee that is to be imposed on health care plans issued by insurers and self-funded employers.

That fee—mandated by the health care reform law to fund research on medical outcomes—will be $1 per plan participant for the first plan year ending after Sept. 30, 2012, and $2 per participant in succeeding years. For plan years starting after Sept. 30, 2014, the fee would be indexed to reflect the percentage increase in national medical expenditures as published by the Department of Health and Human Services.The fee is to be paid annually by July 31 of the next plan year. Many questions have been raised about the fees and to which type of health plans they would apply. “This has been on employers' 2012 health care reform radar screen,” said Andy Anderson, a partner with Morgan, Lewis & Bockius L.L.P. in Chicago.

For example, the proposed regulations that the IRS issued Thursday make clear that the fee would be imposed on retiree-only health care plans, even though such plans are largely exempt from the health care reform law.In addition under the proposed rules, an employer with a health reimbursement arrangement linked to a self-funded high-deductible health care plan would be liable for the fee only for participants in its plan. It would not pay a second fee for participants in the HRA. On the other hand, the fee would be imposed on HRAs if the arrangement were linked to an insured health care plan. In that situation, the employer would be liable for the fee covering participants in the HRA, while the insurer would be liable for the fee on the insured plan.In short, “there will be two fees to be paid,” said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.The proposed regulations also give examples of methodologies that health plan sponsors could use to determine the number of participants in their health care plans for calculating the amount of the fee they would owe.

To view the full article click here

Monday, April 2, 2012

Express Scripts Closes Medco Acquisition .

Expess Scripts Inc. said it completed its $29.1 billion acquisition of Medco Health Solutions Inc. after the Federal Trade Commission determined that the combination of the two largest pharmacy-benefits management companies in the U.S. wouldn't stunt competition in the sector.

The FTC in a majority vote of 3-1 decided that the deal wouldn't change dynamics in the PBM market, ending an eight-month investigation. In a statement the panel said its probe found a "competitive market for PBM services characterized by numerous, vigorous competitors who are expanding and winning business from traditional market leaders."

The probe also showed that Express Scripts and Medco "are not particularly close competitors, the market today is not conducive to coordinated interaction, and there is little risk of the merged company exercising monopoly power," the FTC said.

In a dissenting opinion, FTC Commissioner Julie Brill called the merger "a game changer" and stated, "I have reason to believe that this merger is, in fact, a merger to duopoly with few efficiencies in a market with high entry barriers--something no court has ever approved."
Ms. Brill called on the commission to conduct a retrospective study on the merger in three years' time.

To view the entire article click here.

Friday, March 30, 2012

Experts Agree: Healthcare Vote Stands or Falls with Kennedy's Vote

It is widely beleived that eight of the nine supreme court votes are virutally set in stone on the constititionality of the indivdual mandate required by healthcare reform. Four votes to uphold the law and four votes to strike it down.

The swing vote is to be cast by Justice Anothony M. Kennedy. Below is a link to an article that thoughtfully explains what makes this decision for Justice Kennedy a difficult one.

Click here for the New York Times article.

Monday, March 26, 2012

Early Aruguments Indicate Supreme Court Will Rule This Year on Healthcare Reform

The U.S. Supreme Court opened its historic arguments on President Barack Obama’s health-care overhaul with several justices suggesting they are prepared to rule this year rather than wait for the law to take full effect.

Justices including Stephen Breyer and Ruth Bader Ginsburg today suggested they didn’t view an 1867 law as barring them from ruling immediately on the central question, the law’s requirement that Americans either get insurance or pay a penalty. The 1867 law blocks lawsuits over taxes that haven’t been imposed, and Ginsburg questioned whether health-care penalties would be taxes.

“This is not a revenue-raising measure,” Ginsburg said. “If it’s successful, nobody will pay the penalty and there will be no revenue to raise.”

The court is hearing three days of arguments on the 2010 law, Obama’s biggest legislative achievement. Its decision will determine the fate of a measure designed to extend insurance to about 32 million people and revamp an industry that accounts for 18 percent of the U.S. economy. The court probably will rule by late June, months before the November presidential election.

The six hours of planned debate is the most on a case in 44 years. The justices tomorrow will consider the main issue: whether the government had power to enact the health-care law under its constitutional authority to regulate interstate commerce.

To view the entire article click here

Wednesday, February 15, 2012

Automatic Enrollment for Large Groups Delayed to 2014

A provision in the health care reform law that requires employers with more than 200 employees to automatically enroll new employees in one of their health care plans will not go into effect until 2014, federal regulators say.

In guidance released last week by the departments of Labor, Health and Human Services and the Internal Revenue Service, the agencies said the requirement will not go into effect until regulations are issued. Separately, the Labor Department affirmed its earlier guidance that the automatic enrollment rules won’t be ready until 2014.“In view of the need for coordinated guidance and a smooth implementation process, including an applicability date that gives employers sufficient time to comply, the Department of Labor has concluded that its automatic enrollment guidance will not be ready to take effect by 2014,” it said in a statement.

The statutory automatic enrollment provision, unlike many others in the Patient Protection and Affordable Care Act, itself does not stipulate an effective date.Under the law, employers are required to notify employees about automatic enrollment and to give them an opportunity to opt out of a plan in which they were automatically enrolled.

Thursday, February 9, 2012

Employers Given More Time to Comply With Heath Summary Rule

Employers will have more time to comply with a health care reform law requirement that they provide employees with an “easy-to-understand” summary of benefits and coverage, the Obama administration announced Thursday.



Under the final rule, the new statement—known as an SBC—would apply for plan years beginning on or after Sept. 23.For example, an employer with a plan year that starts Jan. 1 and an open enrollment period that runs from Oct. 1 to Nov. 1 would have to provide the SBC by Oct. 1.Previously, the administration said the information would have had to be distributed by March 23, which benefit experts said would not have given employers enough time to prepare and distribute the information.



The longer compliance period “will be very helpful to plan sponsors, although they still will need to devote significant time and resources to complying with the SBC by this date,” said Debbie Harrison, senior manager-public policy with the National Business Group on Health in Washington.In addition, the amount of information employers would have to provide is reduced compared to the administration’s previous proposal, which said employers would have to provide sample cost information for having a baby, managing Type 2 diabetes and treating breast cancer. Providing an example of the cost of treating breast cancer no longer is required.





To view the article click here

Wednesday, January 25, 2012

House vote on repeal of long-term care program set for next week: Boehner

WASHINGTON—The U.S. House of Representatives next week will vote on legislation that would kill a health care reform law provision to establish a voluntary long-term care program, House Speaker John Boehner said Wednesday.

“Next week, we will repeal the CLASS Act,” the Ohio Republican said during an address before the National Assn. of Health Underwriters conference in Washington. CLASS is the acronym for the Community Living Assistance Services and Supports Act, which was incorporated in the 2010 health care reform law.“Let’s get it off the books,” Speaker Boehner said of the program.Earlier this month, the House Ways and Means Committee approved the bill, H.R. 1173, to kill the program, implementation of which the Obama administration suspended in October as being unworkable.Administration officials said the program would have been unworkable because of its voluntary nature, with massive adverse selection that would have sent health care premiums spiraling.Turning to the health care reform law, which he strongly opposes, Speaker Boehner said its costs ultimately will bankrupt the country.“It will ruin” what has been the world’s best health care system, he said.He noted that the law is transferring to government from consumers health care coverage decisions. As an example, he cited a requirement that will require many health care plan sponsors—including those opposed for religious reasons—to offer coverage for contraceptives.Speaker Boehner did not address the bill’s prospects of passage in the Senate.

To view the entire article please click here.

Wednesday, January 4, 2012

IRS Issues Additional Guidance on W2 Reporting

WASHINGTON—Newly released Internal Revenue Service guidance resolves additional questions employers have raised about a health care reform law provision that will require them to report the cost of health care coverage on employees' W-2 wage and income statements.

Under that requirement, health care cost information will have to be reported on 2012 W-2s, which will be issued in 2013. Under previous IRS guidance, smaller employers—those that distribute fewer than 250 W-2s in 2011—are exempt from this requirement until at least 2014 and possibly longer.

Some exemptions to reporting rule

The latest guidance, released Tuesday, makes clear that employers can—but are not required to—report contributions to health reimbursement arrangements in calculating health care costs.
In addition, the cost of providing coverage through employee assistance programs, wellness programs or on-site medical clinics is not required to be reported if the employer does not charge premiums for the coverage to COBRA beneficiaries.

The guidance also clarifies that the reporting requirement does not apply to Indian Tribal governments.

In all, “This is very helpful guidance,” said Anne Waidmann, a director with PricewaterhouseCoopers L.L.P. in Washington.

The latest guidance also reiterates numerous provisions in last year’s guidance, including that that the cost of coverage that is taxable to employees, such as for a child over age 26, must be reported on the W-2, and that contributions employees make to flexible spending accounts are to be excluded from the health care cost figure.

To view the