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Tag: Patient Protection and Affordable Care Act (PPACA)

House To Vote On Delaying Obamacare’s Individual Mandate

In the House, Republicans will have no problem finding a simple majority to pass legislation that would delay the individual mandate needed to fund the president’s health care reforms.

The GOP spent the last three years voting to repeal Obamacare only to have all of those efforts killed in the Democratically led Senate. But Republicans believe their latest effort has new momentum now that Obama has decided to delay another provision of the law, the employer mandate requiring companies with more than 50 employees to provide health insurance.

The “Fairness for American Families Act,” scheduled for a Wednesday vote, would change the date of implementation of the individual mandate from Dec. 31, 2013, to the same day in 2014.

The mandate requires everyone to either buy health insurance or pay a penalty.

House Speaker John Boehner, R-Ohio, said the Obama administration’s decision to delay only the employer mandate is “unfair and indefensible.”

The legislation may never get consideration in the Senate, but it will put political pressure on Democrats in both chambers who fear that opposing the bill will make it appear as if they are providing a break to big business but not individuals.

Even though Obama has already announced a delay of the employer mandate based on his own authority. But the House insists that such a crucial change requires congressional approval and lawmakers will take up the “Authority for Mandate Delay Act” that would allow them to vote on whether to authorize an action the president has already authorized.

The bill’s author, Rep. Tim Griffin, R-Ark., said the legislation is required because “only Congress can change the law.”

Source: The Examiner

Obamacare Business Mandate Delay Has Minimal Impact On Implementation of PPACA

Obama Administration announced through two blog posts that a provision of the Patient Protection and Affordable Care Act will be delayed one year. The first blog post was on the Department of Treasury website, that a provision of the Patient Protection and Affordable Care Act (PPACA), would be delayed until January of 2015. Mark Mazur, assistant secretary for tax policy at the Treasury Department, in a statement Tuesday that “We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so. We have listened to your feedback. And we are taking action.”

Click here to read more.

Obamacare Delay Helps Employers Prepare

The sudden announcement of a delay of the employer mandate under the Patient Protection and Affordable Care Act may be good news for employers.

In a surprise move last week, the Obama administration announced that it will delay the employer mandate under the Patient Protection and Affordable Care Act (PPACA) one year to 2015, coinciding with when employer reporting will first be due.

While this means employers won’t have to pay fines in 2014, other provisions of the law, like the individual mandate requirements and the opening of the state healthcare Exchanges for January 1, 2014, are still expected to move forward on the administration’s current timeline.

Click here to read more.

HHS and IRS Issue Final Rule and Notices on Individual Mandate-Related Topics

The Internal Revenue Service (IRS) and the Department of Health and Human Services (HHS) issued guidance related to the individual mandate provision of the Patient Protection and Affordable Care Act (PPACA).

The recent guidance included:

A final rule on:

  • How the Exchange/Marketplace and IRS will determine eligibility for, and grant exemption from, the shared responsibility payment; and Standards to determine whether certain health coverage qualifies as minimum essential coverage.
  • A notice explaining eligibility for minimum essential coverage, for purposes of the premium tax credit to purchase coverage on a Marketplace.
  • A notice about transition relief for employees and related individuals who are eligible to enroll in an employer plan with a non-calendar plan year.
  • As a reminder, the individual mandate requires most individuals to have minimum essential coverage or pay a penalty beginning in 2014. The penalty is now called a “shared responsibility payment.” Some individuals may qualify for an exemption so they will not be required to have coverage or pay a penalty. An individual seeking an exemption may do so prospectively – in advance – through an application submitted to the Exchange/Marketplace or retrospectively – after the fact – with the IRS through the tax filing process. An applicant can apply for multiple exemptions simultaneously.

1a.  Final Rule on how the Marketplace and IRS will Determine Eligibility and Exemptions from the Shared Responsibility Payment

The first section of the final rule focuses on the standards and processes the Marketplace and IRS will use to determine eligibility for, and grant exemption from, the shared responsibility payment. With changes noted below, the final rule is largely consistent with our February 7, 2013 news alert, which summarized the proposed rule.

Exemptions still fall under the same broad categories.

  • Individuals who cannot afford coverage
  • Taxpayers with income below the tax filing threshold
  • Individuals who qualify for a hardship exemption
  • Individuals who have a gap in minimum essential coverage of less than three consecutive months in a calendar year
  • Members of religious groups that object to coverage on religious principles
  • Members of health care sharing ministries
  • Individuals in prison
  • Individuals who are not U.S. citizens
  • Members of Native American tribes
  • U.S. citizens residing in a foreign country are typically exempt
  • Changes from the Proposed Rule for Exemptions

The final rule included the following changes:

General:  The final rule specifies, as appropriate, when the Marketplace must make the various categories of exemptions available prospectively or retrospectively.

Religious Principles: Individuals receiving an exemption because they belong to a religious group that objects to coverage on religious principles must re-apply for the exemption upon turning 21. This was changed from the proposed age of 18.

Native American:  The final rule adds an exemption for an individual who is not a member of a federally recognized tribe, but who is eligible for services from the federal Indian Health Service.

Hardship

The final rule:

  • Provides detailed criteria to assist Marketplaces in determining eligibility for a hardship exemption.
  • Clarifies that a hardship exemption will, at a minimum, be provided for the month before the hardship, the month or months of the hardship, and the month after the hardship, and gives the Marketplaces flexibility to provide the exemption for additional months after the hardship.
  • Provides additional detail about how the Marketplace will determine the hardship exemption for “lack of affordable coverage based on projected income.”

1b. Final Rule on What Qualifies as Minimum Essential Coverage

Again, the final rule is largely consistent with our February 7, 2013 news alert, which summarized the proposed rule.

Here is the updated list of what qualifies as minimum essential coverage, including the few noted changes:

  • An employer group health plan
  • An individual health insurance policy
  • A government plan such as Medicare, Medicaid, Children’s Health Insurance Program (CHIP), TRICARE (health care program of the United States Department of Defense Military Health System, formerly known as the Civilian Health and Medical Program of the Uniformed Services or CHAMPUS) or veterans coverage
  • Fully insured student health coverage
  • Self-insured student health coverage *
  • Medicare Advantage plan
  • State high risk pool coverage*
  • Coverage for non-U.S. citizens provided by another country**
  • Refugee medical assistance provided by the Administration for Children and Families
  • Coverage for AmeriCorp volunteers**

* Designated as minimum essential coverage for plan/policy years beginning on or before December 31, 2014.  For coverage beginning after December 31, 2014, sponsors of high risk pool or self-funded student health coverage may apply to be recognized as minimum essential coverage.

** Coverage provided by another country and coverage for AmeriCorps volunteers are no longer automatically deemed minimum essential coverage. However, individuals may apply to have their coverage recognized as meeting minimum essential coverage.

2.  Notice on Eligibility for Minimum Essential Coverage for Purposes of the Premium Tax Credit
An individual may receive health insurance coverage subsidized by the premium tax credit only for months the individual is enrolled in a Qualified Health Plan through a Marketplace and is not eligible for other minimum essential coverage.

The notice explains when an individual is eligible for minimum essential coverage under certain government-sponsored health programs or other coverage as follows:

  • Children’s Health Insurance Program (CHIP) dis-enrollment – If an individual loses CHIP coverage for a period of time because he or she failed to pay premiums, the individual is still treated as eligible for minimum essential coverage through CHIP during that time.
  • CHIP waiting period – If an individual may not enroll in CHIP during a pre-enrollment waiting period, he or she is not eligible for CHIP coverage during that time.
  • Eligibility requiring determination of a disability or diagnosis of a particular disease – An individual is eligible for minimum essential coverage under Medicaid or Medicare in the following circumstances if the responsible agency confirms the findings.

–  Medicaid coverage requiring a finding of disability or blindness
–  Medicare coverage based solely on a finding of disability or illness

  • Eligibility based on enrollment – An individual is eligible for minimum essential coverage if he or she is enrolled in Medicare Part A requiring payment of premiums, a state high risk pool, a student health plan, or a TRICARE program.

3. Notice about Transition Relief for Employees and Related Individuals who are Eligible to Enroll in an Employer Plan with a Non-calendar Plan Year

Employers with non-calendar year health plans may qualify for “transition relief” that allows them to not be subject to penalties under the employer mandate if they comply upon their 2014 renewal date. In the same way, this notice explains that employees and spouses/dependents eligible for an employer-sponsored plan with a non-calendar year may avoid the individual mandate shared responsibility penalty between January 1, 2014 and the start of the 2014 plan year, if they enroll for the 2014-2015 year.

Employees and their spouse/dependents who did not enroll in the employer’s plan for the 2013-2014 plan year are examples of individuals who might benefit from this transition relief. More detailed examples are included in the notice.

For more details, here are links to the various pieces of guidance:

We encourage you to bookmark our health care reform website, InformedOnReform.com.

This document is for general informational purposes only. While we have attempted to provide current, accurate and clearly expressed information, this information is provided “as is” and Cigna makes no representations or warranties regarding its accuracy or completeness. The information provided should not be construed as legal or tax advice or as a recommendation of any kind. External users should seek professional advice from their own attorneys and tax and benefit plan advisers with respect to their individual circumstances and needs.

The Looming Premium Rate Shock

Well the confusion has begun! That is to assume that we all were not already there.

The respected publisher Forbes released an article on May 24, 2013 that shocked everyone. Rates to be offered on the California Insurance Exchange effective 01.01.2014 will actually be lower relative to our existing existing market rates.

Forbes contributor Rick Ungar writes that rates will actually be lower, not higher under Obama Care and the first round of rate releases in California proves this.  Surprising even Ungar, an Obama Care supporter!

These assertions are indirectly backed up by the Congressional Committee of Energy and Commerce  attacking a separate House Report on ACA that reports everyone is about to experience rate shock. Only to be followed up by Forbes article stating that there will be rate shock, rebutting its own Ungar article just a few days earlier.

Read the above links to learn more but know that they are both right.

Those sick and currently paying high rates will no longer be discriminated unfavorably by the insurance industry AND those well and health paying low rates will no longer be discriminated favorably by the industry.

It can be argued both ways by honest people.