HHS

Posted December 10th, 2015 in Producers, Employers, Individuals
Below is a list of some key Affordable Care Act (ACA) changes and facts that will be effective in 2016:
 
  1. The Individual Mandate penalties increase to $695 per adult ($347.50 per child) or 2.5% of household income, whichever is greater. 
  2. The Employer Mandate expands to include all employers who have 50 or more employees. 
  3. The Employer Mandate offer rate increases from 70% to 95%. 
  4. Employer reporting related to the offer of coverage is due for the first time during Q1 2016. 
Posted October 30th, 2015 in Producers, Employers

PCORI Fees

The Internal Revenue Service (IRS) released Notice 2015-60 on October 9, 2015.  The notice includes information on the payable amounts that are due for the Patient-Centered Outcomes Research Institute fees (PCORI fees). The fee will increase from $2.08 to $2.17 per covered life for plan years ending on or after October 1, 2015 and before October 1, 2016. The next round of PCORI fees will be due by July 31, 2016 for plan years ending in 2015. The payment schedule will be as follows:
Posted May 22nd, 2015 in Producers, Employers, Individuals

The Affordable Care Act (ACA) established a maximum out-of-pocket limitation for single and family coverage. The limit established for 2016 is $6,850 for single coverage and $13,700 for family coverage. The Department of Health and Human Services (HHS) issued an FAQ document on May 8, 2015 which indicates a health plan that covers a family cannot impose an out-of-pocket maximum of more than $6,850 for any single family member covered under the plan.

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 October 31st, 2014 in Producers, Employers
Effective October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) Office of e-Health Standards and Services (OESS), the division of the Department of Health & Human Services (HHS) that is responsible for enforcement of compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard transactions, code sets, unique identifiers and operating rules, announces a delay, until further notice, in enforcement of 45 CFR 162, Subpart E, the regulations pertaining to health plan enumeration and use of the Health Plan Identifier (HPID) in HIPAA transactions adopted in the HPID final rule (CMS-0040-F). 
 
This enforcement delay applies to all HIPAA covered entities, including healthcare providers, health plans, and healthcare clearinghouses.
Posted June 27th, 2014 in Producers, Employers, Individuals

On June 26, 2014, the Department of Health and Human Services (HHS) issued proposed regulations on the renewal process for individuals that have purchased health coverage through the Exchange. The regulations aim to streamline the renewal process by auto-enrolling the vast majority of existing members into a health plan for the 2015 plan year.

Posted May 22nd, 2014 in Producers, Employers, Individuals
On May 16, 2014, a new fine was spelled out by the Department of Health and Human Services (HHS) regarding individuals that knowingly and wilfully provide false information to receive subsidies in an Exchange.
 
Posted March 28th, 2014 in Producers, Employers, Individuals

Applies to those who have started the enrollment process and experienced an error

Earlier this week, the Obama administration announced that some consumers will have until mid-April if they were unable to enroll because of an error by the federal exchange or by the Department of Health and Human Services (HHS). People will be able to qualify for an extension by checking a box on HealthCare.gov to indicate that they tried to enroll for on-exchange plans before the deadline. 
Posted March 14th, 2014 in Producers, Employers, Individuals

Last week, the Obama administration released several new Affordable Care Act (ACA) guidelines. Of particular note, any individual or small group with a non-ACA compliant plan will be able to keep that plan in place for additional time.

Posted February 7th, 2014 in Producers, Employers, Individuals
  • The Department of Health and Human Services (HHS) has reported Exchange application submissions have exceeded 3 million.
  • The Congressional Budget Office (CBO) has updated 2014 Exchange enrollment estimates to 6 million.
  • Some reports are showing that 22,000 Exchange applicants were enrolled in the wrong plan or received a lower subsidy than expected,  15,000 Exchange applications were lost and only 11% of Exchange applicants were previously uninsured.

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