Are We ACA Compliant: How to Perform a Self-Audit

Size: px
Start display at page:

Download "Are We ACA Compliant: How to Perform a Self-Audit"

Transcription

1 Are We ACA Compliant: How to Perform a Self-Audit Jennifer L. Berman, JD, SPHR CEO/Chief Employee Optimizer OAU Consulting jberman@oauconsulting.com Agenda for today s presentation: Affordable Care Act Review Employer Mandate ALE status 2015/2016 requirements Minimum Value/Affordability Requirements Cadillac Tax ACA and Self-Funded Health Plans ACA impact on: FSAs HSAs Wellness Programs HR Self-Audit for ACA Compliance The Future of Employer Sponsored Health Care 1

2 Employer Mandate 2015 and Beyond ALE (Applicable Large Employer) status must first be determined. ALEs must offer coverage or pay a penalty. ALE = employs an average of at least 50 FT employees, including FT equivalent employees (FTEs) on business days during preceding calendar year. FT Employee = individual employed with actual hours worked in excess of 30. FTE= # of FT employees PLUS the number of hours of service worked in a month for employees who are NOT FT employees (non-seasonal), divided by 120 To determine FTEs, calculate aggregate number of hours of service worked (not to exceed 120 hours of service for each employee) for employees who are NOT full-time employees for that month and divide by 120. ALE status is determined by adding total number of FT employees and FTEs for each calendar month in prior calendar year and dividing by 12. If result is > 50 FT employee threshold, employer considered an ALE for entire following calendar year, even if number of FT employees and FTEs falls below 50 during year. Options/Exceptions for New Employees, Variable Hour Employees and Seasonal Employees Options/Exceptions for Variable Hour Employees and Seasonal Employees/New Employers Variable Hour Employees: Employer can designate a period of between 3 and 12 months to determine if a variable hour employee is FT. Can also use up to 90-day administrative period. Total can t exceed 1 year. Seasonal Employees: Workers in positions for which customary annual employment is less than 6 months generally not counted as FT employees. New Employers: special rule employers that didn t exist on any business day in prior year will be treated as an ALE if it reasonably expects to employ an avg of at least 50 FT employees, including FTEs, on business days during the current calendar year and it actually employs an avg of at least 50 FT employees, including FTEs on business days during the calendar year. 2

3 Employer Mandate 2015 and Beyond full-time (30+ hours): Must offer coverage to 70% of FT EEs and Dependents* to age : Must offer coverage to 95% of FT EEs and Dependents* to age **: Must offer coverage to 95% of FT EEs and Dependents* to age 26 * Spouses are not dependents for the purposes of the mandate ** For 2015, must certify that they aren t reducing size of workforce to stay below 100 Employer Mandate 2015 and Beyond Must offer coverage that provides Minimum Value 60% of total allowed costs (deductibles, copays, coinsurance, etc.) Minimum value calculator at and is Affordable -- <9.56% of income (new IRS guidelines for 2015) For 2015 plan years, the employer mandate affordability percentage generally 9.56 percent, as well as for premium tax credit eligibility. The affordability percentage for the employer mandate and the premium tax credit eligibility rules is 9.66 percent for

4 Employers that use an affordability safe harbor under the pay or play rules will continue using a contribution percentage of 9.56 percent. Three Safe Harbor Methods for determining: 9.56% of EE W2 wages (reduced for any salary reductions for 401K or FSA 9.56% of EE monthly wages (hourly rate x 130 hours/mo.) 9.56% of Federal Poverty Level for single Penalties for non-compliance with Employer Mandate $2K penalty per FTE (minus first 80 in 2015, less first 30 after that) if ONE FT EE receives federal premium subsidy for marketplace coverage If Plan doesn t provide minimum value or isn t affordable, $3K penalty per FTE receiving subsidy or $2K per FTE (minus first 80 in 2015, less first 30 after that) Begins 2016 (for 2015) IRS notifies if penalties due (they re good at that!) 4

5 Cadillac Tax Minimizing Impact and Exposure Effective 1/1/18 Non-deductible 40% excise tax on high-cost health plans. Levied on the value of Health Insurance benefits above $10.2K for single and $27.5K for family coverage, indexed annually for inflation. Particularly risky for employers with plans tailored to high-risk professions or with large proportion of older employees. Calculated using overall cost of insurance, including premiums, ER/EE contributions, HSA & MSA contributions. Does NOT include dental & vision. HSAs may be a solution but won t know until guidelines issued. Other possible options might be looking at Private Exchanges, increasing OOP costs and reducing spousal eligibility. Required Reporting Applicable Large Employers (< 50 FTEs) Used by IRS to administer excise tax penalties and determine EE eligibility for premium tax credits Forms: 1094-C Transmittal of Employer Level Data 1095-C Employee Statement 1094-B (transmittal) and 1095-B (return) for Self-funded plans Due Dates---Mandatory for 2015 (in 2016) Form 1095-C to EEs by 1/31 File forms 1094-C and 1095-C with IRS by 2/28 or 3/31 if filed electronically by entities required to file at least 250 returns/cal. Year Draft forms and instructions available on IRS Website ( 5

6 Self Funded Health Plans 2015 Health Plan Identification Numbers (HPID) DELAYED INDEFINITELY AS OF 10/31/14 Transitional Reinsurance Fees Part of Premium Stabilization Program Requires SFHPs and health insurers to fund program All HIPAA covered health insurance, early retiree plans, COBRA coverage Does NOT include HIPAA-excepted plans such as limited scope dental/vision; FSAs; EAPs; stand alone RX plans; non-medical treatment Wellness plans; military benefit plans; expat plans; HSAs unless an HDHP used w/hsa. Fee Amt: 2015: $5.25/covered life/mo. (2016: $3.66/life/mo.) To Pay: calculate annual enrollment count, register with Pay.gov website ( upload documentation and make payment. Dates for 2015: 1/15/15: Remit 1 st Contribution Amount ($52.50/covered life) 11/15/15: Remit 2 nd Contribution Amount ($10.50 /covered life) Self Funded Health Plans 2015 Patient Centered Outcomes Research Institute (PCORI) Fee ACA imposes fees on issuers of specified health insurance policies and Self-Funded plan sponsors. Fund for advancing research for making informed health decisions. Applies to most self-funded health plans (different list than Reinsurance Fee). Multiple fee-calculating methods (Actual Count, Snapshot Count, 5500 Method*) need only pay lowest amount. Form 720s due 7/31 for applicable plan year. Civil penalties for failure to file/pay. Fee: $2 per covered life for plan years ending before 10/1/14 $2.08 per covered life for plan years ending before 10/1/15 Adjusts annually with inflation as determined by Secretary of HHS Ends after 9/30/19 6

7 Cafeteria Plans/FSAs 2015 Mid-Year Departures from Cafeteria Plan Eff. 9/18/14, two add l plan change conditions added (one way only drop ER coverage): Carryovers Hours of service reduced to >30 hours/wk but still eligible for group health coverage may revoke election for ER sponsored plan to enroll in another plan that provides minimum essential coverage, such as on public exchange. Coverage must be effective no later than 1 st day of 2 nd month following month in which original coverage is revoked. EE may cease coverage under Group Health Plan when he/she has purchased coverage on Public Exchange, to avoid period of duplicate coverage or no coverage (where ER plan has open enrollment at times other than Calendar year.) Requires Plan Amendment--Catchall may be best way to amend May (not required) amend to allow carryover of up to $500 in unused healthcare FSA contributions to be applied to reimburse health expenses in subsequent plan year. (Changes use it or lose it!) Must amend plan to adopt deadline by end of plan year prior so by 12/31 for this year. Healthcare FSA Contribution Limit 2015: $ must amend plan. HSAs 2015 Limit Increases for Contributions/Deductibles HSA Contribution Limit (ER + EE): $3,350/Ind., $6,650/Family HSA Catch-up (<55): Same HDHP min. deductibles: $1,300/Ind., $2,600/Family HDHP max. out of pocket: $6,450/Ind., $12,900/Family Covering Adult Children ACA allows parents to add adult children up to age 26 to health plans but IRS hasn t changed definition of dependent for HSAs. 7

8 ACA Self-Audit Basics Audit Plan Design Review Grandfathered Status in current plans Does OOP max comply with cost-sharing limits? Does plan still have lifetime max (banned) and compliant annual max? FSA pre-tax contribution limit compliant with IRS guidelines? Is health plan subject to reinsurance fees? Are you still issuing HIPAA certificates for continuation of coverage? Preventive care coverage with no participant cost-sharing included in plan? Does plan waiting period exceed 90 day max? Dependent coverage up to age 26 offered? Cadillac Tax issues evaluated? ACA Self-Audit Basics Audit Required Notices and Filings First, determine which reporting and notification requirements apply to your organization and health plans. Summary of Benefits and Coverage (SBC) and Uniform Glossary Notice Regarding Availability of Health Insurance Exchanges Advance Notification of Certain Benefit Changes Notice of Rescission of Coverage Disclosure of Grandfathered Status Notice of Patient Protections Notices Related to Benefit Claims PCORI fees W-2 Reporting on Cost of Benefits 6055/6056 Reporting 8

9 ACA Self-Audit Basics Audit Employer Shared Responsibility Compliance Applicable Large Employer (ALE) with 50+ full-time equivalent employees ALE status correctly determined? Hourly eligibility requirements compliant with ACA s definitely of FT? IRS approved method used to determine if variable hour employees entitled to coverage? Minimum Essential Coverage (MEC) offered to at least 95% of eligible employees and their dependents? Affordable plan option with minimum actuarial value of at least 60% offered? Plan in place to populate and file 1094-C and 1095-C forms for Sec Health Insurance Coverage Reporting? ACA Self-Audit Evaluate, Strategize and Make Decisions about Healthcare Strategy Considerations: Cost of Pay or Play Penalties Effect of Changing Composition of Workforce Retirees Whether to Obtain Coverage for Employees Through the Health Insurance Marketplace Wellness Program Cost-Saving Potential Coverage Options: Eliminating coverage for PT employees Eliminating coverage for spouses of employees who can obtain health coverage through their own job Steering retirees to private exchanges 9

10 Update on the Exchanges where are we and what s coming? Accelerated adoption of defined contribution funding. Consultancies/Brokers (Hewitt, Aon, Mercer, Tower, Buck, Bloom Health) for Employer marketplace Interesting note: Of EEs given access to these exchanges in 2013, over 40% chose a different plan than what ER previously offered. Health plan-run exchanges target individuals w/o ER coverage: 42% of private insurers will launch a proprietary private exchange by What s Next? Enrollment jumps predicted as extension of coverage takes effect 5% increase in number of employees enrolled in CDHPs to 23% Nearly half of large employers now offer a CDHP (up 10%) Private exchanges starting to gain traction but still very low % Over ½ of employers now include same-sex dependent benefits Wellness incentives increasing in both availability and $$ Number of employers saying they plan to drop coverage is decreasing BUT about 1/3 of employers at risk of hitting excise tax threshold in

11 The Future of Wellness Programs Effectiveness of programs uncertain though very popular Rand Corp survey: Half of organizations with <50 EEs have them Financial incentives tied to health objectives (36% >200ees) and completing health risk assessments (51%) Now a $6 BILLION industry Most of the success of lowered cost appears to be due to penalties that occur when employees don t meet objectives and end up paying more. ACA raised legal limit on penalties to 30% of total premium costs 50% for tobacco users EEOC fighting some aspects of non-voluntary programs with penalties under ADA but no formal guidance issued yet. Longer term disease management (v. lifestyle management) programs appear to be most successful in actually reducing health care costs overall. Where Do We Go From Here? Impact of Generational Attitudes on Health Benefits Millennials embrace technology and see themselves as invincible! Like HDHPs Can stay on parents health plan til 26 (may be better insurance, paid for by mom & dad) Like shopping on line give then the right info and tools and they re good to go Gen X want flexibility Flexible benefit offerings to meet diverse needs for child care, elder care and their own physical/mental health needs Prefer simpler options with more decision-making support Baby Boomers have choices Have highest costs/responsibility burdens ACA removal of lifetime max on medical plans helps Will have options with Medicare education needed 11

12 Where Do We Go From Here? Planning for an Uncertain Future What Should We Be Looking For On The Horizon? Passive enrollment processes may need to be reviewed lack of engagement leads to EE dissatisfaction when they fail to understand plan options and costs. Consumer Driven Health Plans are here to stay. Telehealth may help stretch the healthcare dollar. Explore Private Exchanges expected to be 400 million enrolled by Maximize Wellness programs and avoid potential pitfalls, both in ineffectiveness and compliance. Embrace technology to enable both the savvy millennial shopper and the time-crunched, education-seeking Xer and Boomer. QUESTIONS? 24 12

13 Contact Information Jennifer L. Berman, JD, SPHR CEO/Chief Employee Optimizer OAU Consulting Thank you! 25 13

Texas Association of County Auditors On the Road Area Training January 16, 2014

Texas Association of County Auditors On the Road Area Training January 16, 2014 Texas Association of County Auditors On the Road Area Training January 16, 2014 Health Care Reform: What Counties Need to Know Presented by: Texas Association of Counties Lisa McCaig, Employee Benefits

More information

Affordable Care Act: Evolving Requirements & Compliance Implications

Affordable Care Act: Evolving Requirements & Compliance Implications Affordable Care Act: Evolving Requirements & Compliance Implications Peggy Baron Bricker & Eckler LLP 100 South Third Street Columbus, OH 43215 Employer Shared Responsibility Assessable Payments Beginning

More information

2018 Employee Benefits Webinar Series. Introduction to Consumer Directed Healthcare and Account-Based Plans (HSAs, FSAs, and HRAs) November 15, 2018

2018 Employee Benefits Webinar Series. Introduction to Consumer Directed Healthcare and Account-Based Plans (HSAs, FSAs, and HRAs) November 15, 2018 2018 Employee Benefits Webinar Series Introduction to Consumer Directed Healthcare and Account-Based Plans (HSAs, FSAs, and HRAs) November 15, 2018 Stacy H. Barrow Marathas Barrow Weatherhead Lent LLP

More information

Health Care Reform Update 6/12/2014

Health Care Reform Update 6/12/2014 Health Care Reform Update 6/12/2014 Disclaimer The information contained herein is for general information only. It is not intended as and does not constitute legal or tax advice. The information should

More information

Health Care Reform Under the ACA Its Effect on Municipalities and Their Employees

Health Care Reform Under the ACA Its Effect on Municipalities and Their Employees Health Care Reform Under the ACA Its Effect on Municipalities and Their Employees Maine Municipal Employees Health Trust 1-800-852-8300 www.mmeht.org The Difference Is Trust August 2014 1 Today s Agenda

More information

ACA for Employers Employee Benefits Conference May 15, 2015

ACA for Employers Employee Benefits Conference May 15, 2015 ACA for Employers Employee Benefits Conference May 15, 2015 Presented by: Norma Shirk 1 Agenda Generally Applicable Information Employers & Employees Employer Penalty & 2015 Relief Miscellaneous 2 GENERALLY

More information

Navajo County Schools EBT

Navajo County Schools EBT Navajo County Schools EBT Affordable Care Act (ACA) Update Aaron Polkoski Segal Consulting January 31st, 2014 Copyright 2013 by The Segal Group, Inc., parent of The Segal Company. All rights reserved.

More information

The ACA: Health Plans Overview

The ACA: Health Plans Overview The ACA: Health Plans Overview Agenda What is the legal status of the ACA? Which plans must comply? Reforms currently in place 2013 compliance deadlines 2014 compliance deadlines 2015 compliance deadlines

More information

06/29/2015_830 AM. Healthcare Reform How Will Your Business be Affected in 2015 and Beyond? Introduction

06/29/2015_830 AM. Healthcare Reform How Will Your Business be Affected in 2015 and Beyond? Introduction Healthcare Reform How Will Your Business be Affected in 2015 and Beyond? Introduction Overview of ACA Healthcare Reform in 2015 What s on the Horizon Potential Legislative Actions Patient Protection and

More information

Health Care Reform at-a-glance

Health Care Reform at-a-glance Health Care Reform at-a-glance August 2015 Table of Contents Employer mandate...3 Individual mandate...3 Health plan provisions applying to both grandfathered and non-grandfathered employer plans...4 Health

More information

Monitoring the ACA s. Vital Signs. The Affordable Care Act A Progress Report

Monitoring the ACA s. Vital Signs. The Affordable Care Act A Progress Report Monitoring the ACA s Vital Signs The Affordable Care Act A Progress Report Today s Discussion Affordable Care Act Some Foundational Knowledge Affordable Care Act Compliance Requirements Plan Design Reporting

More information

Affordable Care Act Planning for CPAs. Ben Conley Seyfarth Shaw LLP

Affordable Care Act Planning for CPAs. Ben Conley Seyfarth Shaw LLP Affordable Care Act Planning for CPAs Ben Conley Seyfarth Shaw LLP Overview Background ACA & Taxes Taxes on Employers (and Tax Credits for Employers) Taxes on Individuals (and Tax Credits for Individuals)

More information

Key Elements of Health Care Reform for Employers

Key Elements of Health Care Reform for Employers Key Elements of Health Care Reform for Employers Change in tax treatment for over-age 2010 dependent coverage Early retiree medical reinsurance Accounting impact of change in Medicare retiree drug subsidy

More information

THE AFFORDABLE CARE ACT: PAST, PRESENT & FUTURE October 20, 2015

THE AFFORDABLE CARE ACT: PAST, PRESENT & FUTURE October 20, 2015 HEALTH WEALTH CAREER THE AFFORDABLE CARE ACT: PAST, PRESENT & FUTURE October 20, 2015 CHERYL RISLEY HUGHES WASHINGTON, DC Key Elements of Health Care Reform for Employers 2010 Accounting impact of change

More information

Health Care Reform: Be Prepared for 2014

Health Care Reform: Be Prepared for 2014 Health Care Reform: Be Prepared for 2014 Your Health Care Reform Team: Moderator Eboni Britt POMCO Group Marketing Manager Co-presenter Jessica Marabella POMCO Group Account Manager Co-presenter Amy Zell

More information

Patient Protection and Affordable Care Act

Patient Protection and Affordable Care Act September 27, 2010 Patient Protection and Affordable Care Act 1 9020 Stony Point Parkway Suite 200 Richmond, VA 23235 804-267-3100 Agenda Overview Employer Feedback Terms Components of Health Care Reform

More information

Looking for a Life Vest?

Looking for a Life Vest? Looking for a Life Vest? November 20 th, 2014 @thomasharte Agenda: Looking for a Life Vest? Health Care Reform: What s new with ACA?? Provisions Already in Effect Preparing for Health Care Reform Primary

More information

SHRM Meeting Health Care Reform: Considerations for 2014 / 2015

SHRM Meeting Health Care Reform: Considerations for 2014 / 2015 SHRM Meeting Health Care Reform: Considerations for 2014 / 2015 Bobbie Honesty / Director, Strategic Benefit Services bobbie.honesty@manpowergroup.com May 1, 2014 Disclaimer This presentation is being

More information

ACA UPDATES AND 1095C REPORTING FOR 2016

ACA UPDATES AND 1095C REPORTING FOR 2016 ACA UPDATES AND 1095C REPORTING FOR 2016 Presented By: Bill Heinz Suzie Kaiser Benefit Consultants 10/6/2016 TODAY S FOCUS 1094C/1095C REPORTING OVERVIEW 2016 CHANGES COBRA NON-CALENDAR YEAR PLANS IRS

More information

Hardee s Q4 Franchise System Call. Health Care Reform Update November 5, 2013

Hardee s Q4 Franchise System Call. Health Care Reform Update November 5, 2013 Hardee s Q4 Franchise System Call Health Care Reform Update November 5, 2013 Key Elements of Health Care Reform for Employers Change in tax treatment for over-age 2010 dependent coverage Early retiree

More information

Affordable Care Act Update: Employer Reporting Requirements

Affordable Care Act Update: Employer Reporting Requirements Affordable Care Act Update: Employer Reporting Requirements Presented By: Ryan Wright Account Executive rwright@bbdaytona.com Matthew McGarvey Account Executive mmcgarvey@bbdaytona.com December 12, 2014

More information

Health Care Reform Exchanges, Penalties and Employer Responsibility

Health Care Reform Exchanges, Penalties and Employer Responsibility Health Care Reform Exchanges, Penalties and Employer Responsibility As of April 15, 2013 Table of Contents Exchanges Pages 3-4 Determining Large Employer Status Pages 5-6 Employer Penalty Pages 7-9 Coverage

More information

Healthcare Reform. July 17, 2013

Healthcare Reform. July 17, 2013 Healthcare Reform July 17, 2013 Agenda Current and Future Requirements for Employers Healthcare Reform Taxes and Fees Individual Mandate and Subsidies Employer Pay or Play Mandate Other Requirements Expanded

More information

4/13/16. Provided by: Zywave W. Innovation Drive, Suite 300 Milwaukee, WI

4/13/16. Provided by: Zywave W. Innovation Drive, Suite 300 Milwaukee, WI 4/13/16 Provided by: Zywave 10100 W. Innovation Drive, Suite 300 Milwaukee, WI 53226 Email: marketing@zywave.com Design 2015 Zywave, Inc. All rights reserved. Table of Contents Introduction... 3 Plan Design

More information

1/5/16. Provided by: The Lank Group Winterthur Close Kennesaw, GA Tel: Design 2015 Zywave, Inc. All rights reserved.

1/5/16. Provided by: The Lank Group Winterthur Close Kennesaw, GA Tel: Design 2015 Zywave, Inc. All rights reserved. 1/5/16 Provided by: The Lank Group 2971 Winterthur Close Kennesaw, GA 30144 Tel: 770-683-6423 Design 2015 Zywave, Inc. All rights reserved. Table of Contents Introduction... 3 Plan Design and Coverage

More information

ELECTION UPDATE AFFORDABLE CARE ACT 11/18/2014 WS+B CLIENT CPE

ELECTION UPDATE AFFORDABLE CARE ACT 11/18/2014 WS+B CLIENT CPE AFFORDABLE CARE ACT Anthony Panico, CPA Partner, Healthcare Services Group Team Leader, Healthcare Reform Advisory Team ELECTION UPDATE 1 AFFORDABLE CARE ACT Timeline 2010 Early retiree reinsurance program

More information

ACA Update: Recent Events, the Current Landscape and Preparing for 2018

ACA Update: Recent Events, the Current Landscape and Preparing for 2018 ACA Update: Recent Events, the Current Landscape and Preparing for 2018 November 2017 2017 Employee Benefits Corporation 2 1 Abigail Darwin, Esq. Compliance Consultant Employee Benefits Corporation The

More information

9/18/13. The Affordable Care Act and Challenges for Colleges and Universities Legal Issues in Higher Education October 16, 2013.

9/18/13. The Affordable Care Act and Challenges for Colleges and Universities Legal Issues in Higher Education October 16, 2013. The Affordable Care Act and Challenges for Colleges and Universities Legal Issues in Higher Education October 16, 2013 Overview The ACA: Here to Stay and Why It Matters 2014: The Known and the Unknown

More information

Health Care Reform Health Plans Overview

Health Care Reform Health Plans Overview Health Care Reform Health Plans Overview Topics Status of health care reform Grandfathered plans Timeline for compliance Health Care Reform What is It? Patient Protection and Affordable Care Act (PPACA)

More information

Employer Mandate: Employer Action Overview

Employer Mandate: Employer Action Overview HEALTH CARE REFORM Employer Mandate: Page 2 of 11 Immediatemmediate Employer Action Required Notes Nursing Mothers Employers must provide a reasonable break time for non-exempt employees who are nursing

More information

Affordable Care Act: A Guide for Self-Funded Plans

Affordable Care Act: A Guide for Self-Funded Plans Affordable Care Act: A Guide for Self-Funded Plans Table of Contents Affordable Care Act Updates 3 Grandfathered Plans 4 Benefit and Plan Summary Updates 5 Notifications and Communications 6 COBRA notification

More information

HEALTH CARE REFORM OVERVIEW

HEALTH CARE REFORM OVERVIEW HEALTH CARE REFORM OVERVIEW 1 Health Care Reform General Status On June 28, 2012, the U.S. Supreme Court announced its ruling to uphold the Patient Protection and Affordable Care Act (PPACA) passed by

More information

6/20/13 Presented By: Mike Marchini, Beckie Lewis, & Liz Logsdon or

6/20/13 Presented By: Mike Marchini, Beckie Lewis, & Liz Logsdon or CBIZ PRESENTS Affordable Care Act: The Impact on Your Business & Your Employees 6/20/13 Presented By: Mike Marchini, Beckie Lewis, & Liz Logsdon 301-777-1500 or 800-624-0954 Determine Which PPACA Provisions

More information

Key Features of the Affordable Care Act, By Year

Key Features of the Affordable Care Act, By Year Key Features of the Affordable Care Act, By Year Provision Definition UAB s Status Timeframe 2010 Prohibiting Denying Coverage Based on Pre-Existing Conditions Prevents denying coverage due to a pre-existing

More information

ACA Violations Penalties and Excise Taxes

ACA Violations Penalties and Excise Taxes Provided by Propel Insurance ACA Violations Penalties and Excise Taxes The Affordable Care Act (ACA) includes numerous reforms for group health plans and creates new compliance obligations for employers

More information

HEALTH CARE REFORM GUIDE

HEALTH CARE REFORM GUIDE HEALTH CARE REFORM GUIDE Produced By 866.570.LISI (5474) n www.lisibroker.com Table of Contents An Introduction: Health Care Reform Guide... 3 Defining Individual, Small Group and Large Group... 4 Individual

More information

The Affordable Care Act: Time to Prepare for 2014 and Beyond

The Affordable Care Act: Time to Prepare for 2014 and Beyond The Affordable Care Act: Time to Prepare for 2014 and Beyond Howard Van Mersbergen Vice President of Employee Benefits, Christian Schools International Brian C. Meekhof Benefits Administrator, Christian

More information

Cabrillo College ACA Overview. May 2015

Cabrillo College ACA Overview. May 2015 Cabrillo College ACA Overview May 2015 PURPOSE OF HEALTH CARE REFORM Improve access to healthcare Require health insurance Larger employers must offer comprehensive, affordable coverage Create healthcare

More information

HRAs, HSAs, and Health FSAs What s the Difference?

HRAs, HSAs, and Health FSAs What s the Difference? HRAs, HSAs, and Health FSAs What s the Difference? Updated March 2017 Health reimbursement arrangements (HRAs), health savings accounts (HSAs) and health care flexible spending accounts (HFSAs) are generally

More information

4/13/16. Provided by: KRA Agency Partners, Inc. 99 Cherry Hill Road, Suite 200 Parsippany, NJ Tel:

4/13/16. Provided by: KRA Agency Partners, Inc. 99 Cherry Hill Road, Suite 200 Parsippany, NJ Tel: 4/13/16 Provided by: KRA Agency Partners, Inc 99 Cherry Hill Road, Suite 200 Parsippany, NJ 07054 Tel: 973-588-1800 Design 2015 Zywave, Inc. All rights reserved. Table of Contents Introduction...3 Plan

More information

Welcome Presented by: Sponsored by:

Welcome Presented by: Sponsored by: Welcome Presented by: Sponsored by: Speakers Julie Bunde Director, Product Management, Product & Market Solutions, HealthPartners Ed Wegerson Partner, Employee Benefits and Executive Compensation, Lindquist

More information

Agenda. Play or Pay: Whether & When Decision Tree. HEALTH CARE REFORM (HCR) Latest Changes, New Requirements, Play or Pay Quick Review Special Delays

Agenda. Play or Pay: Whether & When Decision Tree. HEALTH CARE REFORM (HCR) Latest Changes, New Requirements, Play or Pay Quick Review Special Delays HEALTH CARE REFORM (HCR) Latest Changes, New Requirements, and Twists in the Road GPRS Fall Conference, October 30, 2014 Presented By Darcy L. Hitesman, Esq. 763 503 6620 www.hitesmanlaw.com IRS Circular

More information

2016 HEALTH REFORM What you need to know

2016 HEALTH REFORM What you need to know 2016 HEALTH REFORM What you need to know Content Transitional reinsurance fee Out-of-pocket limits SBC changes Instructions for submitting questions: 6055/6056 reporting Health plan identifier FAQs regarding

More information

HEALTH CARE REFORM A FINANCIAL PERSPECTIVE SEPTEMBER 21, 2011

HEALTH CARE REFORM A FINANCIAL PERSPECTIVE SEPTEMBER 21, 2011 HEALTH CARE REFORM A FINANCIAL PERSPECTIVE SEPTEMBER 21, 2011 Elsa Hsu Ching, Mike Sinkeldam, Bill Scott Los Angeles, CA Agenda Health care reform overview and update Health care reform: high employer

More information

THE AFFORDABLE CARE ACT: 2014 AND BEYOND

THE AFFORDABLE CARE ACT: 2014 AND BEYOND THE AFFORDABLE CARE ACT: 2014 AND BEYOND October 28, 2013 Howard Van Mersbergen, Vice President of Employee Benefits, Christian Schools International Julie Sessions, Principal, Mercer Patient Protection

More information

2016 Compliance Checklist

2016 Compliance Checklist Brought to you by Risk Management Advisors, Inc. 2016 Compliance Checklist The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four

More information

AFFORDABLE CARE ACT UPDATES

AFFORDABLE CARE ACT UPDATES AFFORDABLE CARE ACT UPDATES Angela Garner, MBA, CEBS, GBA, RPA, AHIC, LIC Executive Vice President Brown & Brown of Central Michigan agarner@bbcmich.com (989) 714-6592 Updated SBC s and Glossaries-waiting

More information

Important Effective Dates for Employers and Health Plans

Important Effective Dates for Employers and Health Plans Brought to you by Hipskind Seyfarth Risk Solutions Important Effective Dates for Employers and Health Plans On March 23, 2010, President Obama signed the health care reform bill, or Affordable Care Act

More information

Affordable Care Act (ACA) Violations Penalties and Excise Taxes

Affordable Care Act (ACA) Violations Penalties and Excise Taxes Brought to you by Clark & Associates of Nevada, Inc. www.clarkandassoc.com Affordable Care Act (ACA) Violations Penalties and Excise Taxes The Affordable Care Act (ACA) includes numerous reforms for group

More information

Health Care Reform: Legislative Brief Important Effective Dates for Employers and Health Plans

Health Care Reform: Legislative Brief Important Effective Dates for Employers and Health Plans Health Care Reform: Legislative Brief Important Effective Dates for Employers and Health Plans On March 23, 2010, President Obama signed the health care reform bill, or Affordable Care Act (ACA), into

More information

Affordable Care Act: The Road to Compliance Continues

Affordable Care Act: The Road to Compliance Continues A p r i l 2 0 1 4 Affordable Care Act: The Road to Compliance Continues Presented by: Ralph A. Sepe Partner, Health & Benefits Jill R. Bergman Vice President, Compliance SHRM Credit This program has been

More information

HEALTH CARE REFORM: EMPLOYER ACTION OVERVIEW

HEALTH CARE REFORM: EMPLOYER ACTION OVERVIEW CORPORATE BENEFITS COMPLIANCE WHITE PAPER HEALTH CARE REFORM: EMPLOYER ACTION OVERVIEW MARCH 23, 2010 EMPLOYER ACTION REQUIRED NOTES Nursing Mothers Employers must provide a reasonable break time for non-exempt

More information

PPACA A Year End Review

PPACA A Year End Review PPACA A Year End Review November 20, 2014 Jim Hermann, Senior Vice President CEBT, Human Capital Practice Willis of Colorado 2000 South Colorado Boulevard, Tower II, Suite 900 Denver, CO 80222 (303) 773-1373

More information

Health Care Reform under the Patient Protection and Affordable Care Act ( PPACA ) provisions effective January 1, 2014

Health Care Reform under the Patient Protection and Affordable Care Act ( PPACA ) provisions effective January 1, 2014 The New Health Care Landscape Today s Agenda Health Care Reform under the Patient Protection and Affordable Care Act ( PPACA ) provisions effective January 1, 2014 Exchanges and Qualified Health Plans

More information

HEALTH CARE REFORM: THE FACTS, THE TAXES AND THE OPPORTUNITIES October 30, 2013

HEALTH CARE REFORM: THE FACTS, THE TAXES AND THE OPPORTUNITIES October 30, 2013 HEALTH CARE REFORM: THE FACTS, THE TAXES AND THE OPPORTUNITIES October 30, 2013 Denise Angleman, CPIW Regional Senior Vice President Marsh & McLennan Agency LLC Health Care Reform? What is it? Patient

More information

An Employer's Update on Employee Benefits

An Employer's Update on Employee Benefits An Employer's Update on Employee Benefits August 14, 2015 Presented by: Andrea Bailey Powers 205.244.3809 apowers@bakerdonelson.com SAME GENDER SPOUSES Tax-Qualified Retirement Plans Survivor/Beneficiary

More information

Health Care Reform. Employer Action Overview

Health Care Reform. Employer Action Overview Health Care Reform Page 2 of 10 Health Care Reform Immediatemmediate Employer Action Required Notes Nursing Mothers Employers must provide a reasonable break time for employees who are nursing mothers

More information

Solutions for ACA Implementation. berrydunn.com GAIN CONTROL

Solutions for ACA Implementation. berrydunn.com GAIN CONTROL Solutions for ACA Implementation berrydunn.com GAIN CONTROL EMPLOYER PENALTIES: HOW DO YOU KNOW? When Right to Section 1411 Certification 2015 appeal From the Marketplace Certifies that EE has qualified

More information

Affordable Care Act Employer Reporting and Compliance Update

Affordable Care Act Employer Reporting and Compliance Update Affordable Care Act Employer Reporting and Compliance Update Presented by Patrick C. Haynes, Jr., Esq., LL.M. Consulting Brokerage Compliance Communication Administration 2 Patrick C. Haynes, Jr. Today

More information

Affordable Care Act Update

Affordable Care Act Update Affordable Care Act Update CLAconnect.com May 19, 2015 Presented by: Anita Baker Session Objectives Identify key definitions impacting employer implementation of the Affordable Care Act Understand the

More information

Advanced HSA Concepts

Advanced HSA Concepts Advanced HSA Concepts 1 Sue Sieger, ACFCI, CAS Senior Compliance Consultant Employee Benefits Corporation sue.sieger@ebcflex.com The material provided in this webinar is by Employee Benefits Corporation

More information

PPACA Update: Financial Impact on Leavenworth USD 453

PPACA Update: Financial Impact on Leavenworth USD 453 PPACA Update: Financial Impact on Leavenworth USD 453 Health Care Reform Overview What s Next For Employers? Move forward with planning for implementation of all provisions.. In Place Requirements Maintain

More information

Administrative Obligations Workshop. February 5, 2015

Administrative Obligations Workshop. February 5, 2015 Virginia ASBO Administrative Obligations Workshop February 5, 2015 This is only a brief summary that reflects our current understanding of select provisions of the law, often in the absence of regulations.

More information

Crosses the Finish Line. A presentation for the Manufacturer & Business Association

Crosses the Finish Line. A presentation for the Manufacturer & Business Association Health Care Reform Crosses the Finish Line A presentation for the Manufacturer & Business Association Background Statement of the problem 50,000,000 uninsured Healthcare costs rising at 2x 4x annual rate

More information

Employer Shared Responsibility

Employer Shared Responsibility Health Care Reform under the ACA: Employer Shared Responsibility Under new Code Section 4980H, the Affordable Care Act s the Employer Mandate, applicable large employers are now required to: 1) Manage

More information

Health Care Reform Review and Best Practices. Fall 2014 User Group Meeting

Health Care Reform Review and Best Practices. Fall 2014 User Group Meeting Health Care Reform Review and Best Practices Fall 2014 User Group Meeting Disclaimer This presentation is not: Legal advice Tax advice The final word on Health Care Reform A political opinion ADP DOES

More information

2014 and Beyond. This timeline explains how and when the Affordable Care Act (ACA) provisions will be implemented over the next few years.

2014 and Beyond. This timeline explains how and when the Affordable Care Act (ACA) provisions will be implemented over the next few years. December This timeline explains how and when the Affordable Care Act (ACA) provisions will be implemented over the next few years. Get Covered Illinois, the Official Health Marketplace of Illinois While

More information

THE PATIENT PROTECTION AND AFFORDABLE CARE ACT UPDATE

THE PATIENT PROTECTION AND AFFORDABLE CARE ACT UPDATE THE PATIENT PROTECTION AND AFFORDABLE CARE ACT UPDATE February 21, 2013 Jonathan Alexander, Esq. Compliance Counsel Pinnacle Claims Management, Inc. Copyright 2013 Pinnacle Claims Management, Inc. Reproduction

More information

Health Reform Employer Perspective

Health Reform Employer Perspective Health Reform Employer Perspective Copyright 2008 McGraw Wentworth, Inc. All rights reserved. 1 Government Requirements Expanding Federal requirements effecting employers expanded significantly in 2009

More information

NEW YORK STATE AUTOMOBILE DEALERS ASSOCIATION & SYRACUSE AUTO DEALERS ASSOCIATION September 16, 2014 Meeting Syracuse, New York

NEW YORK STATE AUTOMOBILE DEALERS ASSOCIATION & SYRACUSE AUTO DEALERS ASSOCIATION September 16, 2014 Meeting Syracuse, New York NEW YORK STATE AUTOMOBILE DEALERS ASSOCIATION & SYRACUSE AUTO DEALERS ASSOCIATION September 16, 2014 Meeting Syracuse, New York Affordable Care Act Update Are We There Yet? Topics to be Covered Review

More information

Affordable Care Act: What Employers Need to Know to be in Compliance in 2014

Affordable Care Act: What Employers Need to Know to be in Compliance in 2014 Affordable Care Act: What Employers Need to Know to be in Compliance in 2014 October 2013 Stacy H. Barrow sbarrow@proskauer.com 1 Agenda Initial Observations Compliance Calendar Checklist: Important dates,

More information

2013 Miller Johnson. All rights reserved.

2013 Miller Johnson. All rights reserved. Update: How To Prepare For 2014 Tripp W. Vander Wal 1 1 www.millerjohnson.com The materials and information have been prepared for informational purposes only. This is not legal advice, nor intended to

More information

Health Care Reform: What Hospitality and Lodging Businesses Need to Know. June 22, 2010

Health Care Reform: What Hospitality and Lodging Businesses Need to Know. June 22, 2010 Health Care Reform: What Hospitality and Lodging Businesses Need to Know June 22, 2010 Unique Challenges to Hospitality How will health care reform impact the hospitality/lodging industry? Unique aspects

More information

SUMMARY OF QUALIFIED SMALL EMPLOYER HEALTH REIMBURSEMENT ARRANGEMENTS (QSEHRAS) Background

SUMMARY OF QUALIFIED SMALL EMPLOYER HEALTH REIMBURSEMENT ARRANGEMENTS (QSEHRAS) Background SUMMARY OF QUALIFIED SMALL EMPLOYER HEALTH REIMBURSEMENT ARRANGEMENTS (QSEHRAS) The 21st Century Cures Act ("Cures Act"), enacted on December 13, 2016, amended Section 9831 of the Internal Revenue Code

More information

Understanding & Addressing Your 2019 Health and Welfare Benefits Compliance Obligations

Understanding & Addressing Your 2019 Health and Welfare Benefits Compliance Obligations Understanding & Addressing Your 2019 Health and Welfare Benefits Compliance Obligations NOVEMBER 15, 2018 PRESENTERS Carl Pilger, Esq. Director, National Employee Benefit Compliance Services EPIC Insurance

More information

Health Care Reform Update. August 27, 2015

Health Care Reform Update. August 27, 2015 Health Care Reform Update August 27, 2015 Agenda Health Care Reform Year in Review PCORI TRF MLR SCOTUS Employer Mandate 6056 Reporting C Forms 2015 Draft Forms and Instructions Looking Ahead in Health

More information

Health Care Reform: The Financial Impact on the Employer

Health Care Reform: The Financial Impact on the Employer Health Care Reform: The Financial Impact on the Employer WP&BC August 15, 2012 1 1 Supreme Court Examines Constitutionality U.S. Supreme Court Ruling: June 28, 2012 Individual Mandate - Constitutional

More information

The Affordable Care Act What s Ahead for Employer s in 2015?

The Affordable Care Act What s Ahead for Employer s in 2015? The Affordable Care Act What s Ahead for Employer s in 2015? Health Care Reform Refresher The Impact of Health Care Reform on Employers and Individuals The Role of the Insurance Exchanges Health Care Reform

More information

Health Reform Update. Board of County Commissioners Study Session June 30, 2015

Health Reform Update. Board of County Commissioners Study Session June 30, 2015 Health Reform Update Board of County Commissioners Study Session June 30, 2015 Agenda Health Reform Impact Timeline Health Reform Compliance Status Play or Pay Compliance for 2016 2018 Cadillac Tax Update

More information

Health Care Reform Update. April 2013

Health Care Reform Update. April 2013 Health Care Reform Update April 2013 2013 Compliance Issues Summary of Benefits and Coverage Simple explanation of benefits and costs 4 double sided pages, 12 point or larger font Can provide in paper

More information

Health Care Reform Exchanges, Penalties and Employer Responsibility

Health Care Reform Exchanges, Penalties and Employer Responsibility Health Care Reform Exchanges, Penalties and Employer Responsibility as of January 21, 2013 Exchanges Individuals Initial open enrollment will run October 1, 2013 through March 31, 2014 Coverage effective

More information

2014 Hill, Chesson & Woody

2014 Hill, Chesson & Woody Topics for Today Healthcare Reform s Mandates Regulations, Taxes and Fees. Oh my!!! Key Trends What s next? Healthcare Reform s Employer Mandate Background The Employer Mandate portion (4980H) of the Patient

More information

Health Care Reform Compliance: An Employer Perspective

Health Care Reform Compliance: An Employer Perspective Health Care Reform Compliance: An Employer Perspective L& E Breakfast Briefing February 20, 2014 Houston, Texas Presented by: Andrea Bailey Powers 205.244.3809 apowers@bakerdonelson.com Select ACA Provisions

More information

Today s Agenda. The Price Tag. Healthcare: Is Obamacare Causing Intensive Care? Tuesday, March 4, 2014

Today s Agenda. The Price Tag. Healthcare: Is Obamacare Causing Intensive Care? Tuesday, March 4, 2014 HEALTH REFORM ADVISORY PRACTICE Healthcare: Is Obamacare Causing Intensive Care? Tuesday, March 4, 2014 Presented by Mark Holloway, JD, LLM, CEBS Senior Vice President Lockton Benefit Group Compliance

More information

Health Care Reform Toolkit Large Employers

Health Care Reform Toolkit Large Employers Health Care Reform Toolkit Large Employers Table of Contents Introduction... 3 Plan Design and Coverage Issues: 2014 and Beyond... 4 Employer Obligations... 11 Notice and Disclosure Requirements... 19

More information

Health Care Reform: What s In Store for Employer Health Plans?

Health Care Reform: What s In Store for Employer Health Plans? Health Care Reform: What s In Store for Employer Health Plans? April 21, 2010 Presented by: Sue O. Conway sconway@wnj.com (616) 752-2153 Norbert F. Kugele nkugele@wnj.com (616) 752-2186 Copyright 2010

More information

It is the sweet, simple things in life which are the real ones after all.. CPAHU October CE Meeting

It is the sweet, simple things in life which are the real ones after all.. CPAHU October CE Meeting It is the sweet, simple things in life which are the real ones after all.. CPAHU October CE Meeting Heidi M. Bianco, CEBS, CHRS Director of Compliance and HR Consulting AIA/Benefits Resource Group October

More information

Rick Jones, CEBS, ARe March 2014

Rick Jones, CEBS, ARe March 2014 Rick Jones, CEBS, ARe March 2014 Current Issues Taxes New Employer Size Categories Delayed Employer Effective Dates Reporting Exchange Enrollment Minimum coverage / Max Cost Volunteer Firefighters are

More information

2015 Heath Care Reform Compliance Overview

2015 Heath Care Reform Compliance Overview 2015 Heath Care Reform Compliance Overview The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago. Many of these key

More information

Health care reform: Where are we now? An employers guide to

Health care reform: Where are we now? An employers guide to Health care reform: Where are we now? An employers guide to 2014-2016 Presented by: Baker Tilly refers to Baker Tilly Virchow Krause, LLP, an independently owned and managed member of Baker Tilly International.

More information

The Affordable Care Act Update

The Affordable Care Act Update The Affordable Care Act Update Presented by: The Union Labor Life Insurance Company SOLUTIONS FOR THE UNION WORKPLACE SPECIALTY INSURANCE INVESTMENTS Overview I. Key Provisions II. Major Challenges III.

More information

Health Care Reform Overview of the ACA. Presented By: Rae Anne Beaudry, Executive Vice President The Horton Group

Health Care Reform Overview of the ACA. Presented By: Rae Anne Beaudry, Executive Vice President The Horton Group Health Care Reform Overview of the ACA Presented By: Rae Anne Beaudry, Executive Vice President The Horton Group Timeline of Changes and Compliance Measures A. 2010 2015 & Beyond Health Care Reform Timeline

More information

HEALTH CARE REFORM PROVISIONS BY SIZE OF PLAN OR EMPLOYER March 28, 2014

HEALTH CARE REFORM PROVISIONS BY SIZE OF PLAN OR EMPLOYER March 28, 2014 2018 Cadillac Tax: 40% excise tax on the amount by which the total cost of employersponsored health plan exceeds specified thresholds 2010 thresholds are: $10,200 for self-only coverage; $27,500 for other

More information

{ Holmes Murphy & Associates }

{ Holmes Murphy & Associates } { Holmes Murphy & Associates } We re for you. Navigating the Affordable Care Act Texas Municipal Human Resources Association Conference Presenter: Claire Pancerz, Esq. Holmes Murphy & Associates cpancerz@holmesmurphy.com

More information

Health Care Reform Path to Compliance

Health Care Reform Path to Compliance Internal Claims Review and External Review of Appeals processes must be in place (only applies to non-grandfathered plans) One thing s certain, change is constant as employers and employees navigate ate

More information

Stay up-to-date with our compliance news!

Stay up-to-date with our compliance news! Employer Shared Responsibility Health Care Reform Under the ACA Under new Code Section 4980H, the Affordable Care Act s the Employer Mandate, applicable large employers are now required to: Manage employee

More information

The Affordable Care Act: Issues for Employers

The Affordable Care Act: Issues for Employers The Affordable Care Act: Issues for Employers Paul W. Madden Whiteford, Taylor & Preston L.L.P. (401) 347-8742 Direct Fax: (410) 223-4162 pmadden@wtplaw.com Topics Covered Employer Shared Responsibility

More information

HEALTH CARE REFORM PROVISIONS BY TYPE AND SIZE OF PLAN Last Rev. July 14, 2014

HEALTH CARE REFORM PROVISIONS BY TYPE AND SIZE OF PLAN Last Rev. July 14, 2014 2010: First Plan Year on or after September 23, 2010 Extension of dependent coverage up to age 26 No pre-existing condition exclusions for enrollees under age 19 No lifetime dollar limits on "essential

More information

Health Care Reform Summary Patient Protection and Affordable Care Act (PPACA)

Health Care Reform Summary Patient Protection and Affordable Care Act (PPACA) Health Care Reform Summary Patient Protection and Affordable Care Act (PPACA) Contents The following information summarizes the PPACA s impact on employers, individuals, the health industry and plan design,

More information

5GBenefits, LLC Your Health Care Reform Partner

5GBenefits, LLC Your Health Care Reform Partner 5GBenefits, LLC Your Health Care Reform Partner Are you in compliance with health care reform regulations? We can help you stay on top of health care reform in order to avoid penalties from legislative

More information