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Individual Out-of-Pocket Maximums must Apply for Family Coverage in 2016

By   /  June 29, 2015  /  Cost-Sharing (Reductions), Health Care Reform  /  No Comments

family-wellness

Starting with the 2016 plan yea­r the self-only, in-network annual out-of-pocket maximum (OOPM) applies to each individual, even those enrolled in family coverage.  Although the ACA limits on cost-sharing have applied since 2014, before 2016 the maximums applied separately for self-only and “other-than-self-only” (family) coverage.  Recent guidance (since February 2015) from the Departments of HHS, […]

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2016: “Small” group increases to 100 Employees; and Embedded Individual OOPM Applies to All Size Plans

By   /  June 28, 2015  /  Cost-Sharing (Reductions), Health Care Reform, Small Employers  /  No Comments

expanded-100-employees2

As employers start preparing for 2016 renewals, here are two important changes to keep in mind: “Small” group definition increases to 100 employees, and Embedded individual out-of-pocket maximum (OOPM) applies for all size plans “Small” Group Definition Starting with the 2016 plan year, “small” group increases to 100 employees.  Under the ACA, the definition is […]

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Supreme Court Rules Same-Sex Marriage is Legal Nationwide

By   /  June 26, 2015  /  Health Care Reform  /  No Comments

same-sex-marriage

The Supreme Court ruled 5-4 that gay marriage is legal nationwide. The U.S. Constitution guarantees same-sex couples the right to marry. The case is Obergefell v Hodges issued June 26, 2015.

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Supreme Court Rules in Favor of ACA on Subsidies

By   /  June 25, 2015  /  Exchanges / Marketplaces / Subsidies, Health Care Reform  /  No Comments

supreme-court-building

The US Supreme Court ruled (6-3) today that federal tax subsidies under the Affordable Care Act are available to people who purchase individual health policies in both federal and state exchanges.   The majority opinion said “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.  If at all possible, we must interpret the […]

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SBC Final Rule—June 2015

By   /  June 24, 2015  /  Health Care Reform, Summary of Benefits and Coverage  /  No Comments

health and human services

On June 16, 2015, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) published final regulations on the summary of benefits and coverage (SBC) and uniform glossary requirement under the Affordable Care Act (ACA). These regulations generally finalize the December 2014 proposed regulations, with the following minor changes, explained below […]

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Wellness Plans: Update on Recent Guidance from EEOC, DOL, HHS, and Treasury

By   /  June 23, 2015  /  Health Care Reform, Wellness Programs  /  No Comments

US Capitol Building

Two sets of guidance issued in April of this year could require changes to some employers’ wellness plans. This article summarizes the recent guidance and the proposed changes, and suggests areas where employers may wish to be cautious in their wellness plan design.

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Seasonal Employees: Who are they and why does it matter?

By   /  June 21, 2015  /  Employer Mandate, Health Care Reform, Large Employers  /  No Comments

seasonal-employees

The determination of which employees are “seasonal employees” has taken on new importance for “applicable large employers” (ALEs) because the Affordable Care Act (ACA) measurement method rules allow employers to treat full-time seasonal employees differently from full-time non-seasonal employees, for purposes of group health plan eligibility. Misclassifying employees as seasonal employees may result in penalties for an ALE. This article explains it all.

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IRS Releases 2015 Draft Forms 1094 and 1095 for Information Reporting

By   /  June 21, 2015  /  Health Care Reform, Large Employers, Reporting Requirements  /  No Comments

1095-B

On June 16, 2015, the IRS released draft versions of 2015 forms 1094 and 1095. These 2015 draft forms are largely unchanged from the 2014 versions, except for a few minor changes noted below.

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2015 Federal Poverty Levels

By   /  June 19, 2015  /  Health Care Reform  /  No Comments

minimum-wage-dollar

The following table is the 2015 Poverty Guidelines for the 48 Contiguous States and the District of Columbia. The table below lists 100%, 138%, 150%, 250%, 300%, 350% & 400% of the FPL

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California Adopts FT/FTE Counting Method to Determine Small Group Market Eligibility

By   /  June 16, 2015  /  Small Employers, State-Specific Information  /  No Comments

california cal/OSHA

In 2016, when California’s small group insurance market expands to include employers of up to 100 employees, employers in the state will use the same method of counting full time and full-time equivalent employees towards that threshold, as is required under the ACA’s employer shared responsibility rules. This will be the effect of Senate Bill 125, which has been enrolled and sent to Governor Brown . . .

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