Affordable Care Act

Posted May 15th, 2015 in Producers, Employers
The third installment of the Patient-Centered Outcomes Research Institute (PCORI) fees will be due on July 31, 2015. As its name suggests, PCORI is a research institute, and it was created by the Affordable Care Act (ACA) as a way to improve clinical effectiveness. It is partially funded by fees charged to health plans. Here is information and some reminders about the upcoming fee that is due.
 
  • The fee is paid on the average number of covered lives for the plan year ending in 2014.
Posted May 1st, 2015 in Producers, Employers, Individuals
There have been several attempts to dismantle the Affordable Care Act (ACA) and none have prevailed up to this point. The House of Representatives voted nearly 40 different times to repeal the law with no avail. The constitutionality of the Individual Mandate was challenged and ultimately upheld by the Supreme Court. Now we are awaiting a decision on whether the federal government can legally provide subsidies to Exchange applicants.  
 
Posted April 24th, 2015 in Producers, Employers

The Affordable Care Act (ACA) has eliminated the need for certificates of creditable coverage (a.k.a. HIPAA notices) as of this year. These notices detailed the amount of time a person was covered under a health plan, and their primary purpose was to reduce or eliminate pre-existing condition waiting periods when someone was changing from one health plan to another. Since the ACA has eliminated pre-existing condition waiting periods in almost all market segments, these notices are deemed to be no longer relevant.

Posted March 27th, 2015 in Producers, Employers, Individuals

On March 4, 2015 the U.S. Supreme Court heard oral arguments in regards to the King vs. Burwell case, which is the most significant challenge to the Affordable Care Act (ACA) since the constitutionality of the Individual Mandate was challenged back in 2012. The plaintiffs in the King vs. Burwell case argue that subsidies can only be provided by states that establish an Exchange on their own. They further argue that the federal government, which is utilized in 37 states, cannot provide subsidies to Exchange applicants.  

Posted March 20th, 2015 in Producers, Employers, Individuals
The Department of Health and Human Services (HHS) issued nearly 500 pages of regulations that impact various components of the Affordable Care Act (ACA). These regulations were posted to the Federal Register on February 27th, and they take effect 60 days from the posting unless otherwise indicated in the regulations. Included in the final regulations are some key changes to Special Enrollment Periods (SEPs) for individual market coverage which are outlined below:  
Posted March 16th, 2015 in Producers, Employers

The IRS has released Notice 2015-17 with some new information about Employer Payment Plans, which are plans that are used to reimburse employees with pre-tax dollars for individual market coverage (e.g. HRA). Previous guidance had essentially eliminated Employer Payment Plans as an option for actively employed workers because they would not be able to comply with all of the Affordable Care Act (ACA) market reforms. Notice 2015-17 elaborates on the IRS’ position of Employer Payment Plans.

Posted February 23rd, 2015 in Employers, Producers

The IRS has released the final version of the forms and instructions as it relates to the new employer reporting requirements associated with the Employer Mandate and other Affordable Care Act (ACA) provisions. The forms are identical to the draft versions that were released last summer, but there have been revisions made to some of the instructions. The forms and instructions can be accessed below:

Section 6055 reporting (used to report which individuals are covered by the employer sponsored plan)

Posted February 13th, 2015 in Producers, Employers

The Affordable Care Act (ACA) defines a small employer as one with up to 100 employees, but the law gave states the ability of using a definition of up to 50 employees until the end of 2015. As a result, most states, including Illinois, used a definition of up to 50 employees. However, that will change in 2016, and all states will be required to classify their small group market as up to 100 employees.

Why does this matter?

Posted February 6th, 2015 in Producers, Individuals
The Affordable Care Act (ACA) requires most people in the country to have health insurance coverage or pay a penalty. In addition, advanced premium tax credits were provided to millions of people who enrolled in coverage through a state-run or federally-facilitated Exchange. The government will be assessing penalties and reconciling subsidy payments on federal income tax returns effective for 2014.
 
Posted January 23rd, 2015 in Producers, Employers, Individuals

The IRS has released the maximum penalties that are payable by individuals who are without minimum essential coverage in 2015 and who do not qualify for an exemption from the Individual Mandate.

The maximum penalties for this year are the greater of:

  • $325 per uninsured adult or $162.50 per uninsured child under age 18. The maximum penalty using this method is capped at $975.

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