Archived ACA Updates
Dec. 22, 2014: Proposed Regulations on SBC Issued. The U.S. departments of Treasury, Labor and
Health and Human Services issued
proposed regulations on the summary of benefits and
coverage (SBC) and the uniform glossary. A
fact sheet is available as well. The proposed rule would add features to make the SBC more user-friendly by streamlining and shortening its length.
Dec. 19, 2014: Proposed Rules on Excepted Benefits. The proposed rules would allow group health plan sponsors, in limited circumstances, to offer wraparound coverage to employees who are purchasing individual health insurance in the private market, including through the Health Insurance Marketplace. Read the news release and the proposed rules.
Nov. 19, 2014: EBSA Issues Updated Guidance. The Employee Benefit Security Administration (EBSA) updated the following compliance PDF:
Compliance Assistance Guide - Health Benefits Coverage Under Federal Law. There are changes in these specific sections on mental health parity:
For more information on mental health parity issues, contact Kathryn Wilber, senior counsel, health policy, at (202) 289-6700.
Transitional Reinsurance Program News
- Updates to FAQs: The IRS issued answers to two questions regarding the treatment of contributions made under the reinsurance program as ordinary and necessary business expenses. Read the FAQs here.
The IRS has issued guidance indicating that meeting the ACA's 'minimum value' standard will require plans to provide both physician and hospital coverage. According to the American Benefits Council (ABC), Internal Revenue Service (IRS) Notice 2014-69, issued on behalf of the U.S. Department of the Treasury and the Department of Health and Human Services (HHS), reiterates the departments' view that "plans that fail to provide substantial coverage for in-patient hospitalization services or for physician services (or for both) ... do not provide the minimum value intended by the minimum value requirement." Recently, some employers and consultants argued they could achieve minimum value based on using the HHS minimum value calculator without providing coverage for hospitalization. The IRS guidance provides relief for employers who planned to introduce a non-hospital services/non-physician services plan.
A new set of Affordable Care Act (ACA) FAQs addresses limitations on cost-sharing. The FAQs were produced jointly by the Departments of Labor, Health and Human Services and the Treasury. Read the FAQs.
IRS has released a draft IRS form 1095c along with draft instructions that represent the process self-funded employers with more than 50 employees will follow to report information about employees and employer health coverage under Sections 6055 and 6056 of the Affordable Care Act. The IRS has created a single, combined draft form that self-funded employers may use this purpose, along with draft instructions:
The Chief Counsel of the IRS has posted guidance via a memorandum and a Q&A regarding FSA and HSA procedures, carryovers and eligibility:
News and Discussion About the ACA
In The Alliance Blog:
President & CEO Cheryl DeMars participated in a health care roundtable convened by InBusiness in March 2013. Read the discussion here: "Health Care Roundtable: Will the Affordable Care Act Live Up to Its Name?"
Resources for Employers on High-Impact ACA Provisions
Compliance Tools for Self-funded Employers
- The US Department of Labor's Employee Benefits Security Administration (EBSA) is the enforcement agency for employers on most non-tax related ACA provisions. EBSA has created two self-compliance tools for employers that serves as a guide to ensure your plan is compliant with new provisions of the Affordable Care Act. EBSA is available to answer any questions you may have by phone at 866.444.EBSA (3272).
- For questions about tax-related ACA provisions, the IRS has created a web page listing fact sheets and guidance on Affordable Care Act provisions. A separate page lists legal opinions and resources.
- A new website, business.USA.gov/healthcare, provides information specifically for employers regarding the Affordable Care Act. This ACA "wizard" is designed to provide guidance specific to employers by size.
Employer Responsibility, or Pay or Play Provisions
Other Tax-Related Issues Impacting Self-funded Plans
Plan Design and Reporting Requirements
Provisions Having an Indirect Impact on Employers
If Employees Have Questions:
Official Guidance for Employers from Federal Agencies
FAQ from the U.S. Department of Labor
- Visit the main page for ACA
- Part I – Q & A about grandfathered status, internal appeals and external review, dependent coverage, o-of-network emergency services, and highly compensated employees.
- Part II – Q & A about grandfathered status, dental and vision benefits, and preventive health benefits.
- Part IV – Q & A about grandfathered status and lifetime limits applicable to essential health benefits.
- Part V – Q & A about preventive health benefits and value-based insurance designs, auto-enrollment, notice requirements for plan changes, adult dependent coverage, pre-existing exclusions, grandfathered plans, the Mental Health Parity and Addiction Act (MHPAEA), and wellness program initiatives.
- Part VI – Q & A about grandfathered status
- Part VII – Q & A about about four-page summary of benefits and MHPAEA.
- Part VIII– Q & A about Summary of Benefits and Coverage (SBC)
- Part IX – Q & A related to the implementation of the SBC
- Part X – Q & A about providing an SBC for the Medicare Advantage package
- Part XI – Q & A about a number of issues. Confirms that employers will not be required to issue notices to employees about exchanges until regulations are issued later in 2013.
- Part XII – Q & A that clarifies provisions impacting plan designs for self-funded plans and the coverage of preventive services.
- Part XIII – Q & A addressing expatriate plans.
- Part XIV – Q & A about SBC requirements. Provides new clarifications and a link to updated templates.
- Part XV – Q & A about annual limit waiver expiration dates, provider nondiscrimination rules, coverage for those in clinical trials, and transparency reporting.
- Part XVI – Q & A about issuing the Notice of Coverage Options and complying with the 90-day waiting period limitation.
- Part XVII – Q & A about Mental Health Parity Implementation
- Part XVIII – Q & A about preventive services, out-of-pocket limits, expatriate health coverage, wellness programs, fixed indemnity insurance, mental health parity
- Part XIX – Q & A about COBRA continuation coverage, out-of-pocket maximums, preventive services, SBCs.
- Part XX– Q & A about disclosure with respect to Preventive Services