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Tag: healthcare reform

BREAKING: HHS Secretary Kathleen Sebelius Resigns

HHS Secretary Kathleen Sebelius has resigned her post barely a week after the close of the tumultuous initial open-enrollment period for the healthcare reform law’s insurance exchanges.

The six-month signup period was plagued by technology problems that initially thwarted consumers’ attempts to enroll in coverage. But it closed with a surge of interest that ultimately saw the Obama administration top its goal of 7 million enrollments. The tally has grown to 7.5 million, Sebelius testified during a budget hearing on Capitol Hill just hours before her resignation was reported.

Read the full report here.

The I.R.S.’s Final Mandate Reporting Rules? Still Complicated

Last summer, the Obama administration delayed implementing the employer mandate in the Affordable Care Act because, it said, it needed time to figure out how it might simplify the law’s complicated reporting requirements for businesses with 50 or more employees. “We don’t necessarily need to load up the vast majority of companies that are already doing the right thing with a bunch of additional paperwork,” President Obama told The Times in an interview in July, asking, “Are there simpler ways for us to allow them to certify that they’re providing health insurance?”

But the final regulations were released last week, and business groups are complaining that the only streamlining the Internal Revenue Service appears to have achieved is for itself.

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.

Forever 21 Bumps Fraction Of Workforce Below PPACA

The teen-focused clothing maker has cut back all its line workers to 29.5 hours a week in an apparent move to get around the health care benefits trigger of the Patient Protection and Affordable Care Act.

The company didn’t cite the PPACA as the impetus for its decision — quite the opposite. It insisted that the decision was made “independent of the Affordable Care Act.” Rather, it was strictly the result of an internal audit of stores that indicated a new workforce design was needed, it said. As part of its response, Forever 21 also noted that it has promoted and converted 421 part-time store employees to full-time status since March of this year.

Click here to read full article.

Workplace Wellness: Improving Health and Controlling Health Care Spending

According to the U.S. Department of Health and Human Services, chronic disease is responsible for 7 out of 10 deaths among Americans every year. And we know that the costs associated with treating individuals with chronic conditions account for the majority of annual spending on medical care.

Across the country, more employers are learning how nondiscriminatory employer-based prevention and wellness programs can help improve the overall health of our workers and control health care spending—and the Affordable Care Act is making it easier.

The Cost of Chronic Disease and the Benefits of Workplace Wellness

HHS reports that the cost of treatment for those with chronic conditions like heart disease, cancer, strokes, and diabetes accounts for over 75% of our annual medical care costs. In addition to these direct costs, the indirect costs associated with poor health –such as worker absenteeism, reduced productivity, and disability — may be significantly higher. According to the Centers for Disease Control and Prevention (CDC), these productivity losses due to personal and family health issues can cost U.S. businesses $1,685 per employee per year, or $225.8 billion annually.

To view the final rules related to new incentives for employer wellness programs under the Affordable Care Act, click here.

Click  here to read full article.

ACA Requirements To Consider for 2014

Many plan sponsors had been waiting for the Supreme Court’s decision on the Affordable Care Act (ACA) to fully launch the next phase of compliance and that they should review the upcoming requirements to make sure they are prepared to comply.

Here is a checklist of ACA requirements that apply to group health plans and plan sponsors for 2014.

Except where noted, these requirements generally apply to all group health plan coverage—insured and self-funded—including grandfathered plans. However, each requirement may have its own set of exceptions for more limited benefits, such as those excepted under the Health Insurance Portability and Accountability Act (HIPAA) or retiree-only coverage.

Plan sponsors should review this checklist and make sure they have a strategy for completing their own “to-do” lists.

2014 CHECKLIST

  • Individual mandate. Starting January 1, 2014, most U.S. taxpayers must be enrolled in “minimum essential coverage” or pay a penalty. Minimum essential coverage includes exchange coverage, individual insurance coverage, Medicare and most employer-sponsored coverage. We are waiting for guidance as to a more specific meaning of minimum essential coverage.
  • Exchange coverage begins. Starting January 1, 2014, state-based exchanges will be up and running. Where a state does not create an exchange, the U.S. Department of Health and Human Services (HHS) will create a federal exchange. Health coverage may be purchased on an individual basis through the exchange, even if an individual is eligible for employer coverage. Those who fall below certain income thresholds may qualify for a premium credit under the exchange. Small employers may be able to purchase group coverage through special Small Business Health Operations Program (SHOP) exchanges.
  • Employer mandate: Play or pay. Beginning in 2014, employers will be required to offer minimum essential coverage or face a penalty. Coverage will be considered to meet this standard if it passes an affordability test, stipulating that employee premiums not exceed 9.5% of the employee’s income, and a minimum value test stipulating coverage must have a value of 60%, presumably when compared to the employee cost share.
  • Waiting periods of 90 days. For plan years starting on or after January 1, 2014, waiting periods under group health plans may be no longer than 90 days.
  • Coverage for clinical trials. For plan years starting on or after January 1, 2014, group health plans must cover certain clinical trial costs and may not discriminate against individuals who participate in qualified clinical trials. We are waiting for more guidance on this provision. Grandfathered plans are excluded from this requirement.
  • Increased wellness program incentives. For plan years starting on or after January 1, 2014, the incentive amount that group health plans may offer under health-based wellness programs governed by the HIPAA wellness rules is increased from 20% of the cost of employee coverage to 30%.
  • No annual dollar limits on essential health benefits. For plan years starting on or after January 1, 2014, group health plans may no longer impose annual dollar limits on essential health benefits. Similar lifetime dollar limits were prohibited starting for plan years on or after September 23, 2010. Since then, plans have been permitted three years to phase in the restrictions; however, this policy will end, beginning in 2013.
  • No pre-existing condition exclusions (PCEs). For plan years starting on or after January 1, 2014, group health plans must eliminate all PCEs.
  • Cost-sharing limits. For plan years starting on or after January 1, 2014, group health plans must limit cost-sharing or out-of-pocket maximums to $5,950 for individuals and $11,900 for families; these are today’s numbers and will be adjusted for cost of living before 2014. Grandfathered plans are excluded from this requirement.
  • Deductible limits. For plan years starting on or after January 1, 2014, group health plans may not impose a deductible higher than $2,000 per individual or $4,000 per family (indexed). There is much debate about whether this provision applies only to the small group market or to the large group market, as well, and more guidance would be welcome. Grandfathered plans are excluded.
  • Essential health benefits. Starting in 2014, insured plans in the individual and small group markets must cover each of the essential benefits categories listed under the ACA. Grandfathered plans, self-funded plans and insured plans in the large group market are excluded.
  • Reinsurance fee. HHS will assess a fee on “contributing entities” to fund a reinsurance program to help cover costs for high-risk individuals in the individual market during the rollout of the exchange. A “contributing entity” is defined as a health insurance issuer or third party administrator (TPA) on behalf of self-insured group health plan coverage. The reinsurance fee will be payable for only three years—2014 to 2016—and will be collected on a quarterly basis starting January 15, 2014. The fee will be based on the number of covered lives under the plan, but HHS has yet to provide more specific guidance on the amount or how to calculate the fee. However, in the first year, the fee must total at least $10 billion on a national basis.
  • Insurer provider fee. Starting in 2014, insurers must pay an annual fee on net written health insurance premiums, calculated by dividing the covered entity’s net premiums by the net premiums of all covered entities and then multiplying this fraction by a set annual amount. In 2014, this amount will be $8 billion.
  • IRS reporting for employers (Sections 6055 and 6056). Starting in 2014, there will be an Internal Revenue Service (IRS) annual reporting requirement that applies to any entity that provides minimum essential coverage, which generally includes any “eligible employer-sponsored plan” (Internal Revenue Code [IRC] Section 6055). A separate reporting requirement requires large employers (generally, those with at least 50 full-time workers) to report to the IRS whether they offer full-time employees minimum essential coverage (IRC Section 6056).

Source: PlanSponsor.com