Cost-Sharing (Reductions), Laws, Regulations & FAQs, Notices & Disclosures (Sample forms), Preventive Services, Summary of Benefits and Coverage

Recent Benefits News May 9th, 2014

benefit changes 2014

IRS Announces 2015 Dollar Limits for HSAs & HDHPs

IRS Rev. Proc 2014-30 (April 23, 2014) increases the Health Savings Account (H.S.A.) maximum annual contribution for 2015 by $50 for individuals and $100 for families (from $3,300 to $3,350 for individuals and from $6,550 to $6,650 for families).   The matrix in the Article  provides easy-to-read list of 2014 and 2015 dollar limits for H.S.A.s and for “high deductible health plans” (HDHPs). Note  that in 2015 the PPACA and HDHP out of pocket maximums will be different.


Affordable Care Act Implementation FAQs from the DOL, Part XIX 

These FAQs (issued 5/2/2014 by DOL, HHS & IRS) cover a number of issues:

1) New updated DOL Model COBRA notices

2) With respect to the annual out-of-pocket maximum, how large group market coverage and self-insured group health plans should treat an individual’s out-of-pocket costs for a brand name prescription drug, when a generic was available and medically appropriate.

3)  If large group market coverage or self-insured group health plan has a reference-based pricing structure, under which the plan pays a fixed amount for a particular procedure (e.e.g, a knee replacement), and which certain providers will accept as payment in full, how the out-of-pocket limit applies for a provider does not accept that amount as payment in full.

4)  What are plans and issuers expected to provide as preventive coverage for tobacco cessation interventions?

5)  How is a permissible carryover amount for a health FSA taken into account with regards to the maximum benefits payable limit for health FSAs under the excepted benefit regulations?

6) What templates should plans and issuers use for the SBCs and the uniform glossary required to be provided after the second year of applicability?

7) Which safe harbors and other enforcement relief will be extended, regarding SBCs and the uniform glossary.  Available at


DOL Issues Revised Model COBRA Notices & Proposed Regulations

1- Model COBRA Election Notice (for Use by Single-Employer Group Health Plans), Updated May 2, 2014 (MS Word Doc)

Modifiable, electronic form for election of COBRA coverage. Adds the following new language to the COBRA Election notice:  “there are limitations on plans’ imposing a preexisting condition exclusion and such exclusions will become prohibited beginning in 2014 under the Affordable Care Act.”     Available at

2-  Model General Notice of COBRA Continuation Coverage Rights (for Use by Single-Employer Group Health Plans), Updated May 2, 2014 (MS Word Doc)
Modifiable, electronic form for general notice of COBRA availability. [OMB Control Number 1210-0123 (expires 10/31/2016).]Available at

3- Text of DOL Proposed Regs Amending Notice Requirements Pertaining to Health Care Continuation Coverage (COBRA)
These proposed regulations amend existing COBRA notice requirements to better align with the ACA provisions already in effect and that will become applicable in the future. The proposed regulations replace the current version of the model COBRA notices with the noted above (items #1 & #2).   Available at


IRS Addresses HRA Coverage for Non-Dependent Domestic Partners

The IRS has released a private letter ruling (201415011) that addresses the tax consequences of providing HRA coverage to employees’ domestic partners. The arrangement at issue was established to provide HRA benefits to employees and retirees of various state governmental entities, with benefits funded by the entities’ contributions to a VEBA.

Available at


Larger Employers in the San Francisco Bay Area must offer Commuter Benefits to Covered Employees by September 30, 2014

A new rule under the Bay Area Commuter Benefits Program requires that, by September 30, 2014, all “Covered Employers” must offer and implement at least one of the listed commuter benefit options for all “Covered Employees.”  A “Covered Employer” is one with an average of 50 or more full-time employees who perform work within nine listed San Francisco Bay Area counties.  Click Here for the full Article.

ACA and Small Businesses: Economic Issues

This report: 1) explains how employer-sponsored insurance can be used to address concerns about health insurance coverage and cost; 2) summarizes the three ACA provisions most relevant to small businesses;  3) analyzes these provisions for their potential effects on small businesses;  and 4) presents several approaches that could address some concerns associated with these provisions (particularly the employer penalty).” (Congressional Research Service)

White House Press Release.  FACT SHEET:  Affordable Care Act by the Numbers

Includes information such as:

1)  8 million people signed up for private insurance in the Health Insurance Marketplace. For states that have Federally-Facilitated Marketplaces, 35 % of those who signed up are under 35 years old and 28 % are between 18 and 34 years old.

2)  3 million young adults gained coverage by being able to stay on their parents plan.

3)  3 million more people were enrolled in Medicaid and CHIP as of February, compared to before the Marketplaces opened. Medicaid and CHIP enrollment continues year-round.

4)  5 million people are enrolled in plans that meet ACA standards outside the Marketplace, according to a CBO estimate.

New Data Signal Smaller Jump in Health Care Costs for  2015

“Statisticians working with insurers to project next year’s insurance premium rates say they expect to see an average increase of about 7%, well below the feared double-digit increases making recent headlines.”  This USA Today article quotes Dave Axene, a fellow with the Society of Actuaries, who says he expects  next year’s premiums to increase 6% to 8.5% overall.  Before the ACA, premiums rose an average of 7-10% a year. The article also references a report from the IMS Institute for Healthcare Informatics, which found that “Americans spent $329.2 billion on health care last year—up 3.2% from 2012 and a rebound after spending went down 1% in 2012.”  (USA TODAY)


IRS Final Regs on Information Reporting by Exchanges 

These final regulations implement IRC section 36B(f)(3) and  provide detailed rules for information reporting by Exchanges on enrollments in qualified health plans.  Information reporting (to the IRS and to tax payers) by Exchanges, large employers and insurers is necessary to reconcile the premium tax credit with advance credit payments and to administer the premium tax credit generally.  28 pages. The IRS previously issued regulations on information reporting by large employers & by plans.



CMS Notice of Special Enrollment Periods and Hardship Exemptions for Persons Meeting Certain Criteria (PDF)

HHS previously extended a hardship exemption to individuals who purchased health insurance through the federal Exchange/Marketplace and will have coverage no later than May 1, 2014.  The exemption means that these individuals will not have to pay the Individual Mandate tax or penalty for those months from January until the effective date of the coverage.  In this notice, CMS extends the hardship exemption from the tax to those individuals who bought “minimum essential coverage” (MEC) outside the Exchange as well. Additionally,  CMS is providing a special enrollment period for individuals eligible for COBRA, so they can elect coverage through the federal Exchange, because they might not have enrolled during the regular open enrollment period because they thought they could enroll after their COBRA expired.     5/1/2014


CMS Notice of Special Enrollment Period for Individuals Losing Coverage through the Pre-Existing Condition Insurance Program (PCIP) on April 30, 2014 (PDF)

HHS is providing a special enrollment period for individuals who lose coverage through PCIP because the program terminates PCIP enrollees will have until June 30th, 2014 to select a plan.   4/24/2014

CMS Explanation of Application of the SHOP Participation Provision by Issuer (PDF) 

HHS has developed [a] state-by-state list of issuers (carriers) who have greater than 20 percent small group market share in their respective states, based on earned premiums reported for MLR purposes (2012 data).” [CMS has released a certification form for use by issuers.]  The reason this matters is because carriers who have more than 20% small group market share must offer at least one silver-level QHP and one gold-level QHP through the Federally-facilitated SHOP as a condition of participation in the Federally facilitated individual market Exchange. 5/5/2014