Healthcare Marketplace Applications Available

On September 26, the Department of Health and Human Services (HHS) released the final applications that individuals will use to apply for coverage on the new Health Insurance Marketplace/Exchange beginning October 1. The applications are posted on the Centers for Medicare and Medicaid Services (CMS) website.

These applications will be used in all states with federally facilitated or state partnership Marketplaces. The applications for state-run Marketplaces may differ. The applications will be used both to apply for coverage and to determine whether an individual or family is eligible for a subsidy.

There are three different applications and instructions for each:

·         Individual Short Form – For single adults with no dependents who are not eligible for employer health coverage and who want to determine if they are eligible for subsidies.

·         Standard Form – For anyone who is eligible for employer health coverage and wants to determine if they are eligible for subsidies.

·         Individual Without Financial Assistance – Form that can be used by anyone who does not want to provide employment and income information to determine if they are eligible for subsidies.

Beginning October 1, the forms can be completed online through www.healthcare.gov, or paper forms can be submitted by mail.

What Employers Need to Know

The Standard application includes a section where individuals who are eligible for employer-sponsored health coverage will need to provide information about that coverage.

·         If the employer sent the Marketplace Notice – including the optional page 3 – to all employees as required by October 1, individuals will have all the information they need to complete that part of the application.

·         If the employer did not send the Marketplace Notice or did not include page 3 of the notice, the individual will not have all the information needed to complete the application.

Page 2 of the Marketplace Notice includes basic information about which employees and dependents are eligible for coverage. The optional page 3 indicates whether the individual receiving the notice is eligible for coverage that meets the minimum value standard, the cost of employee-only coverage and what changes the employer is planning to make for the next plan year.

The Standard application includes a section called the Employer Coverage Tool, which individuals are instructed to take to their employer to get the required information about their employer coverage. The Employer Coverage Tool includes the same information as the Marketplace Notice. All information in the Marketplace Notice and the Employer Coverage Tool is numbered in the same way to make it easier for individuals to transfer the information to the application.

The Application Process

All consumers will be directed to www.healthcare.gov to get information about Marketplace coverage. They will have the opportunity to answer a few questions about their age, the state where they live and whether they currently have coverage. If they live in a state that has a state-run Marketplace, they will be directed to their state Marketplace for more information.

Individuals will complete an application to determine if they are eligible for a subsidy and to review coverage details and premiums for the plans for which they are eligible. They must enroll by December 15 for coverage to be effective on January 1, 2014. The enrollment period will continue through March 31, 2014.

Marketplace Application Checklist

According to a checklist published on www.healthcare.gov, individuals will need the following information to complete the application:

·         Social Security Numbers or document numbers for legal immigrants.

·         Employer and income information for every member of the household who needs coverage – for example, pay stubs or W-2 forms.

·         Policy numbers for any current health insurance plans covering members of the household.

·         Information about every job-based plan someone in the household is eligible for, even if they are not enrolled in the plan.

Links to the Applications

Use these links to review the applications:

Individual Short Form

Individual Short Form Instructions

Standard Form

Standard Form Instructions

Individual without Financial Assistance

Individual without Financial Assistance Instructions

Online enrollment for health exchanges delayed for small businesses

Reuters

 

Sep. 26, 2013 at 12:58 PM ET

The Obama administration will delay online Obamacare enrollment for small businesses in federally operated healthcare exchanges until Nov. 1, one month later than planned, an administration official said on Thursday.

The official, who spoke on the condition of anonymity, said small businesses that want to purchase healthcare coverage for their employers would still be able to enroll beginning Oct. 1 through paper applications, in-person meetings or over the phone to a federal call center.

The official gave no reason for the delay.

Officials at the U.S. Department of Health and Human Services, which is spearheading implementation of President Barack Obama's healthcare law, were not immediately available for comment.

Word of the delay in so-called SHOP exchange online enrollment comes five days before online healthcare marketplaces for individuals and small businesses are scheduled to begin signing up uninsured people for coverage on Oct. 1. Coverage is scheduled to begin on Jan. 1.

This is also the latest in a series of delays at the federal and state level and could raise new questions about how well the marketplaces will operate in the initial weeks and months.

Copyright 2013 Thomson Reuters.

HHS: Significant choice and lower than expected premiums available in the new Health Insurance Marketplace

To view today's press release from the Department of Health and Human Services please click below:

http://www.hhs.gov/news/press/2013pres/09/20130925a.html

Agencies Release Guidance on HRAs, Health FSAs and Cafeteria Plans

On Sept. 13, 2013, the Internal Revenue Service (IRS) and the Department of Labor (DOL) issued technical guidance on how certain market reforms under the Affordable Care Act (ACA) apply to health reimbursement arrangements (HRAs), health flexible spending accounts (FSAs) and other similar arrangements.

This guidance is contained in IRS Notice 2013-54 and DOL Technical Release 2013-03. The Department of Health and Human Services (HHS) is also issuing guidance to show that it agrees with the IRS’ and DOL’s interpretation.

The guidance applies for plan years beginning on or after Jan. 1, 2014, but can be applied for all prior periods.

Annual Limits and Preventive Care

The ACA requires non-grandfathered group health plans to cover certain preventive care services without imposing any cost sharing. For plan years beginning on or after Jan. 1, 2014, the ACA prohibits group health plans from placing annual dollar limits on the coverage of essential health benefits.

Prior guidance provided that an HRA integrated with other group health coverage is not required to satisfy the annual limit restrictions if the other coverage alone satisfies the ACA’s annual limit restrictions. The latest guidance includes the following points:

·      An HRA will comply with the preventive care services requirements if the group health plan with which the HRA is integrated complies with the preventive care services requirements.

·      A group health plan, including an HRA, used to purchase coverage on the individual market cannot be integrated with that individual market coverage for purposes of the ACA’s annual dollar limitation or preventive care services requirements. For example, a group health plan, such as an employer payment plan, that reimburses employees for an employee’s substantiated individual insurance policy premiums will fail to satisfy the market reforms for group health plans because the plan:

o     Imposes an annual limit up to the cost of the individual market coverage purchased through the arrangement;  and

o     Cannot be integrated with any individual health insurance policy purchased under the arrangement.

·      Only health FSAs that are offered through a Code Section 125 plan (or cafeteria plan) are exempt from the ACA’s annual limit prohibition. The DOL intends to amend its annual limit regulations to clarify this exemption, applicable Sept. 13, 2013. (Note that these health FSAs must comply with the annual $2,500 limit on health FSA salary reduction contributions.)

·      Health FSAs that do not qualify as excepted benefits will fail to meet the ACA’s preventive care services requirements because they are not integrated with group health plans.

·      Unused amounts that were credited to an HRA while the HRA was integrated with other group health coverage may be used to reimburse medical expenses after an employee ceases to be covered by the other group health coverage without causing the HRA to fail to comply with the ACA’s requirements on annual limits and preventive care.

·      In general, an integrated HRA violates the ACA’s annual limit prohibition if the group health coverage does not cover a category of essential health benefits and the HRA is available to cover that category of benefits and limits the coverage to the HRA’s maximum benefit. However, if the group health coverage provides minimum value, there is no violation.

HRAs—Two Integration Methods

The IRS’ and DOL’s guidance includes two ways for an HRA to be considered integrated with a group health plan for purposes of the annual dollar prohibition and the preventive care services requirements. Under either method, the HRA and the other group coverage are not required to have the same plan sponsor or the same plan document, or to file a single Form 5500 (if applicable).

Under both methods, an employee must be permitted to permanently opt out of and waive future reimbursements from the HRA at least annually. This opt-out feature is required because the HRA’s benefits generally will constitute minimum essential coverage and would disqualify an individual from claiming the ACA’s premium tax subsidy.

Employee Assistance Programs (EAPs)

Benefits under an EAP are considered to be excepted benefits that are not subject to the ACA’s market reforms, but only if the program does not provide significant benefits in the nature of medical care or treatment.

Premium Tax Subsidy

For purposes of the premium tax subsidy, the affordability and minimum value requirements do not apply if an employee enrolls in any employer-sponsored minimum essential coverage, including coverage provided through a cafeteria plan, an employer payment plan, a health FSA or an HRA, but only if the coverage does not consist solely of excepted benefits. If an employee enrolls in any employer-sponsored minimum essential coverage, he or she is ineligible for the ACA’s premium tax subsidy.

An HRA that has fewer than two participants who are current employees on the first day of the play year (for example, a retiree-only HRA) is also considered minimum essential coverage. As a result, a retiree covered by a stand-alone HRA for any month will not be eligible for a premium tax subsidy for that month.

Cafeteria Plans

Beginning in 2014, individual coverage through an Exchange cannot be reimbursed or paid for under a cafeteria plan. For cafeteria plans that as of Sept. 13, 2013 operate on a plan year other than a calendar year, this restriction will not apply before the first plan year that begins after Dec. 31, 2013. However, individuals may not claim a premium tax subsidy for any month in which they are covered by an individual plan purchased through an Exchange as a benefit under a cafeteria plan.

No Fine for Failure to Issue Notice of Coverage Options per DOL

From the DOL Website:

Q: Can an employer be fined for failing to provide employees with notice about the Affordable Care Act's new Health Insurance Marketplace?

A: No. If your company is covered by the Fair Labor Standards Act, it should provide a written notice to its employees about the Health Insurance Marketplace by October 1, 2013, but there is no fine or penalty under the law for failing to provide the notice.
The notice should inform employees:

• About the Health Insurance Marketplace;
• That, depending on their income and what coverage may be offered by the employer, they may be able to get lower cost private insurance in the Marketplace; and
• That if they buy insurance through the Marketplace, they may lose the employer contribution (if any) to their health benefits

The U.S. Department of Labor has two model notices to help employers comply. There is one model for employers who do not offer a health plan and another model for employers who offer a health plan or some or all employees:

• Model Notice for employers who offer a health plan to some or all employees
• Model Notice for employers who do not offer a health plan

The model notices are also available in Spanish and MS Word format at http://www.dol.gov/ebsa/healthreform/.
Employers may use one of these models, as applicable, or a modified version. More compliance assistance information is available in a Technical Release issued by the US Department of Labor.

IRS Struggling to Combine Reporting Requirements

Source: Lifehealthpro.com

The Internal Revenue Service is still trying to figure out how to combine two new Patient Protection and Affordable Care Act (PPACA) information reporting programs.

One of the new programs, described in Section 6056 of the Internal Revenue Code, requires a health coverage issuer to tell the IRS and consumers whether it is providing "minimum essential coverage."
The other, described in IRC Section 6056, requires a large employer to tell the IRS whether it is meeting the PPACA "shared responsibility" requirements -- the employer mandate requirements -- by offering full-time workers affordable coverage with a minimum value. An employer that violates the mandate rules could have to pay a penalty of $2,000 per affected worker.

The IRS will publish the PPACA Section 6055 MEC reporting requirement and PPACA Section 6056 shared responsibility reporting requirement draft regulations in the Federal Register Monday.
Comments will be due 60 days after the publication date.

The IRS asked for comments on the IRC Section 6055 and IRC Section 6056 reporting programs in April 2012.

Many commenters asked the IRS to combine the reporting programs.
Combining the programs will be complicated, because the programs apply to different types of entities and will generate different types of information, IRS officials said in the preamble to the Section 6056 reporting program draft.

The Section 6055 MEC requirements apply to the coverage issuers, such as insurers, and those issuers have to report the Section 6055 information only for people who actually have coverage, officials say. The individuals will use the MEC information to qualify for subsidies and see if they owe individual mandate penalties.

The Section 6056 shared responsibility reporting requirements apply to large employers, and those employers must report on the coverage they have offered workers, whether or not the workers have agreed to take the coverage, officials said.

In some cases, the IRS may let large employers use information reported on Form W-2 and information reported to meet the Section 6055 MEC reporting requirements to meet the Section 6056 shared responsibility requirements, officials said.

The IRS is considering letting employers meet the Section 6056 shared responsibility reporting requirements by using a code on the W-2.

Also in the draft, officials:

• Declined to let employers with fiscal years other than the ordinary calendar year to base Section 6055 or Section 6056 reporting on the fiscal year. Consumers need the coverage information early in the calendar year, officials said.
• Declined to create a "safe harbor" from penalties for coverage issuers or employers that violate reporting rules because other parties cause problems. Another provision already offers issuers and employers relief for any errors that are corrected in a timely manner, officials said.
• Said that the insurer that insures a group health plan, not the group plan sponsor, is responsible for meeting the Section 6055 MEC reporting requirements for the group plan members.

Comments on the draft regulations will be due 60 days after the official Federal Register publication date

Proposed Rules Would Ease Employers Health Plan Reporting Burden

Business Insurance

Newly proposed Internal Revenue Service and Treasury Department health care reform regulations would ease the amount of employee plan coverage information employers would have to report to federal regulators.

Under the proposed rules, released Thursday, employers would not be required to report cost information related to family coverage.In addition, employers would have to report how much of the premium employees will have to pay for single coverage only.Limiting that reporting requirement to single coverage is appropriate, the IRS and the Treasury Department said because a health care reform law affordability test applies only to single coverage — not family coverage.Under that test, if the premium paid by employees for single coverage exceeds 9.5% of household income, the employee is eligible for a federal premium subsidy to purchase coverage in a public insurance exchange. If the employee uses the subsidy, the employer may be liable for a $3,000 penalty. No penalty is assessed regardless of how much the employer charges for family coverage, making the need to collect such information unnecessary, regulators said.“Because only the lowest-cost option of self-only coverage offered under any of the enrollment categories for which the employee is eligible is relevant to the determination of whether coverage is affordable — and thus to the administration of the premium tax credit and employer shared responsibility provisions — that is the only cost information proposed to be requested,” according to the proposed regulation, which is scheduled to be published in the Sept. 9 Federal Register.

While regulators have reduced the amount of information to be reported, “it is only limited relief. There still will be a massive amount of work to meet the reporting requirements,” said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.The proposed rules, though, could pose problems in other areas. For example, employers would be required to report tax identification numbers of employees’ dependents.Employers do not always have such information for every dependent, said Amy Bergner, managing director of human resources in Washington for PricewaterhouseCoopers L.L.P.

For the original article click here

DOL Issues FAQ Part XVI

Set out below are additional Frequently Asked Questions (FAQs) regarding implementation of various provisions of the Affordable Care Act. These FAQs have been prepared jointly by the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments). Like previously issued FAQs (available at http://www.dol.gov/ebsa/healthreform/ and http://www.cms.gov/cciio/resources/fact-sheets-and-faqs/index.html), these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended.

Notice of Coverage Options Available Through the Exchanges

Section 18B of the Fair Labor Standards Act (FLSA), as added by section 1512 of the Affordable Care Act, generally provides that, in accordance with regulations promulgated by the Secretary of Labor, employers must provide each employee notice of coverage options available through a Health Insurance Marketplace (also referred to as an Exchange). On May 8, 2013, the Department of Labor issued Technical Release 2013-02 provided temporary guidance on FLSA section 18B, as well as model notices.⁽¹⁾

Q1: Is it permissible for another entity (such as an issuer, multiemployer plan, or third-party administrator) to send the Notice of Coverage Options on behalf of an employer to satisfy the employer's obligations under FLSA section 18B?

Yes, an employer will have satisfied its obligation to provide the notice with respect to an individual if another party provides a timely and complete notice. The Department of Labor notes that, as explained in Technical Release 2013-02, FLSA section 18B requires employers to provide notice to all employees, regardless of whether an employee is enrolled in, or eligible for, coverage under a group health plan. Accordingly, an employer is not relieved of its statutory obligation to provide notice under FLSA section 18B if another entity sends the notice to only participants enrolled in the plan, if some employees are not enrolled in the plan. When providing notices on behalf of employers, multiemployer plans, issuers, and third party administrators should take proper steps to ensure that a notice is provided to all employees regardless of plan enrollment, or communicate clearly to employers that the plan, issuer, or third party administrator will provide notice only to a subset of employees (e.g., employees enrolled in the plan) and advise of the residual obligations of employers with respect to other employees (e.g., employees who are not enrolled in the plan).

90-day Waiting Period Limitation

PHS Act section 2708 provides that a group health plan or health insurance issuer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days. Section 2704(b)(4) of the PHS Act, section 701(b)(4) of ERISA, and section 9801(b)(4) of the Code define a waiting period to be the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan.
On February 9, 2012, the Departments issued guidance outlining various approaches under consideration with respect to PHS Act section 2708 and solicited comments. After reviewing those comments, the Departments provided temporary guidance on August 31, 2012, to remain in effect at least through the end of 2014, regarding the 90-day waiting period limitation. This guidance also solicited comments. After consideration of all of the comments received in response to the February 2012 and August 2012 guidance, the Departments published proposed regulations on March 21, 2013.
The proposed regulations generally provide that a group health plan or health insurance issuer offering group health insurance coverage may not impose a waiting period that exceeds 90 days. The proposed rules also provide that a waiting period is the period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll under the terms of the plan can become effective. For this purpose, being otherwise eligible to enroll in a plan generally means having met the plan's substantive eligibility conditions (such as being in an eligible job classification or achieving job-related licensure requirements specified in the plan's terms). However, eligibility conditions based solely on the lapse of time are permissible for no more than 90 days. Other conditions for eligibility under a plan are generally permissible unless the condition is designed to avoid compliance with the 90-day waiting period limitation. The proposed regulations provide several illustrations of how to apply this rule.⁽²⁾
The preamble to the proposed regulations stated that, in the Departments' view, the proposed rules were consistent with, and no more restrictive on employers than, the August 2012 guidance.⁽³⁾ Therefore, the Departments stated they will consider compliance with the proposed rules as compliance with PHS Act section 2708 at least through 2014.⁽⁴⁾

Q2: Will the Departments be issuing final regulations under PHS Act section 2708 that give plans and issuers sufficient time to comply with the waiting period limitation?

Yes. As stated in the proposed rules, plans and issuers can rely on guidance provided in the March 2013 proposed rules at least through 2014. To the extent final regulations are more restrictive on plans or issuers than the proposed regulations, they will not be effective prior to January 1, 2015 and the Departments expect they will give plans and issuers sufficient time to comply.⁽⁵⁾
Under the proposed rules, to the extent plans and issuers impose substantive eligibility requirements not based solely on the lapse of time, these eligibility provisions are permitted if they are not designed to avoid compliance with the 90-day waiting period limitation. Therefore, for example, if a multiemployer plan operating pursuant to an arms-length collective bargaining agreement has an eligibility provision that allows employees to become eligible for coverage by working hours of covered employment across multiple contributing employers (which often aggregates hours by calendar quarter and then permits coverage to extend for the next full calendar quarter, regardless of whether an employee has terminated employment), the Departments would consider that provision designed to accommodate a unique operating structure, (and, therefore, not designed to avoid compliance with the 90-day waiting period limitation).

Footnotes

1. See Technical Release 2013-02, model notice for employers who offer a health plan to some or all employees, and model notice for employers who do not offer a health plan, available at http://www.dol.gov/ebsa/healthreform/.
2. See paragraph (c)(3)(i) and (ii) of the proposed regulations, addressing the application of plan provisions requiring certain hours-of-service per period to variable hour employees and cumulative service requirements.
3. 78 FR 17317, March 21, 2013.
4. Id.
5. 78 FR 71313, 17317 (March 21, 2013).