ACA

Posted July 7th, 2016 in Producers, Employers, Individuals
It should be pretty clear by now that two of the biggest provisions of the Affordable Care Act (ACA) are the Individual and Employer Mandates. The Individual Mandate requires all Americans to have a health insurance plan or pay a penalty, unless an exemption applies. Factors that may influence the amount of the Individual Mandate penalty include household size and income. The Employer Mandate requires employers with 50 or more employees to offer health insurance coverage to at least 95% of its full-time employees or risk penalties.
Posted July 1st, 2016 in Producers, Employers
The Department of Health and Human Services (HHS) recently issued a final rule which effectively implements Section 1557 of the Affordable Care Act (ACA). The new rule prohibits certain discriminatory acts from occurring for health programs or activities that are administered by HHS, including plans that are sold on federal and state Marketplaces. 
 
Posted June 15th, 2016 in Producers, Employers
In part one and part two of this series, we examined how employees are increasingly responsible for their own healthcare costs and have adjusted their expectations accordingly. We conclude this series with an important announcement:
 
Posted June 1st, 2016 in Producers, Employers
In the first part of this series, we discussed how everyone from insurance companies to employers has been affected by the Affordable Care Act (ACA), but no group more so than employees - the true healthcare consumer.
 
Posted May 23rd, 2016 in Producers, Employers
As required under the ACA, the federal government must conduct audits of Marketplace coverage to ensure that only people who are truly eligible are receiving a subsidized plan.
 
Effective Spring 2016, CMS launched an "Employer Initiatives" Program to aid in the auditing process. As part of this program, CMS may contact an employer to request whether or not one or more employees were enrolled in minimum essential coverage, or whether or not they were offered a health plan which was affordable and had minimum value. 
 
Posted May 18th, 2016 in Producers, Employers
Since the Affordable Care Act (ACA) took effect, Flex has been following closely as the market transitions further away from traditional healthcare concepts. The following is the first piece in a three-part series that addresses key industry issues, trends and solutions related to Consumer-Driven Accounts (CDAs).
 
Posted March 24th, 2016 in Producers, Employers
Whether it be the ACA, COBRA, ERISA, HIPAA, Section 125, or another regulation, employers can find themselves out of compliance somehow, and they may not even be aware. Here is a list of some common areas of non-compliance, not ranked in any particular order.
 
Posted March 18th, 2016 in Producers, Employers, Individuals
We can categorize health insurance plans in a number of different ways. There are fully-insured and self-insured plans, HMOs and PPOs, high deductibles and low deductibles, and metallic tiers (bronze, silver, gold and platinum) which are used in some market segments. There’s also one other way to categorize health insurance plans, and that’s by their “grandparent” status. The grandparent status determines which Affordable Care Act (ACA) rules a health insurance plan must comply with.
 
Grandfathered Plans 
Posted March 11th, 2016 in Producers, Employers, Individuals

Each year the Department of Health and Human Services (HHS) issues a set of rules referred to as the “Notice of Benefit and Payment Parameters.”  This set of rules generally addresses changes and new requirements that apply to certain provisions of the Affordable Care Act (ACA). 

Posted February 26th, 2016 in Producers, Employers, Individuals
The Centers for Medicare and Medicaid Services (CMS) recently announced a new process that will impact anyone seeking to enroll with a special enrollment period (SEP) on the Healthcare.gov website.  Under the current process, individuals who experience a qualifying event simply need to check a box on the application to be eligible for an SEP.

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