Menu Close

Tag: employer compliance with the affordable care act

No Means No and States Carry On

The Obama Administration released two new key pieces of health reform regulatory guidance, including a series of FAQs that even further clarify the Administration’s preexisting position that if an employer creates some type of premium reimbursement arrangement to pay for health coverage, then that arrangement is subject to all federal health law market reform requirements, even if the reimbursement is for individual insurance coverage premiums.

The Administration’s prior guidance explains that employer healthcare arrangements, such as HRAs and employer payment plans, are group health plans that typically consist of a promise by an employer to reimburse medical expenses up to a certain amount. The guidance released on November 6th, clarifies that such arrangements are subject to the group market reform provisions of the Affordable Care Act, including the prohibition on annual limits under Public Health Service Act (PHS Act) section 2711 and the requirement to provide certain preventive services without cost sharing under PHS Act section 2713.

The Administration’s guidance further clarifies that such employer healthcare arrangements will not violate these market reform provisions when integrated with a group health plan that complies with such provisions. However, an employer healthcare arrangement cannot be integrated with individual market policies to satisfy the market reforms. Consequently, such an arrangement may be subject to penalties, including excise taxes under section 4980D of the Internal Revenue Code.

Read the full report here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

cosby ig logo

The Affordable Care Act—Countdown to Compliance for Employers

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ushered in broad national standards aimed at improving the efficiency and effectiveness of the U.S. health care system. Referred to generically as “administrative simplification,” these rules govern the areas of privacy and security of health information, electronic health care transactions and code sets, and unique health identifiers. In the years that followed, the Department of Health and Human Services (HHS) issued comprehensive rules in each of these areas. A summary of these rules is available here.

HIPAA established national standards for transmitting health data electronically and using standard code sets to describe diseases, injuries and other health conditions and problems. The statute envisioned a system that uses one identification number per employer, health plan or payer and health care provider to simplify administration when engaging in the electronic processing of certain standard transactions. Examples of standard transactions include health care eligibility benefit inquiry and responses, health care claim status requests and responses, health care services reviews, health care claim payment/advice, health care claims (medical, dental or institutional), payroll deducted and other group premium payment for insurance products, and benefit enrollment and maintenance. Compliance with the HIPAA rules governing transactions and code sets is required only where information is transmitted between two HIPAA “covered entities” (i.e., certain providers, health plans, and clearinghouses) under one of the transactions referred to above.

Read the full article here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.