President Trump has signed an executive order calling upon federal agencies to consider expanding health care options in 3 major areas to potentially increase competition and lower costs. Until further guidance is issued or legislation is signed, however, all current ACA requirements remain in effect, including penalties for noncompliance.
The following are key highlights of the order:
For more information on this executive order, click here.
Note: In general, executive orders must be implemented in a manner consistent with applicable law, including the Administrative Procedure Act, which requires extended review of and public comment on any federal rules which may be proposed as a result of an executive order. Going forward, we will promptly report changes made to any ACA requirements.
For more information on the ACA, check out our Health Care Reform section.
Effective as of October 6, 2017, two companion interim final rules issued by the U.S. Departments of Health and Human Services, Treasury, and Labor expand exemptions related to the Affordable Care Act requirement that non-grandfathered group health plans provide coverage without cost-sharing for contraceptive services (referred to as the “contraceptive mandate”). Previously, the contraceptive mandate was subject to exemptions for religious employers and accommodations for certain other non-profit religious organizations and closely held for-profit entities with sincerely held religious beliefs against certain contraceptives.
The new rules exempt entities that object to establishing, maintaining, providing, offering, or arranging (as applicable) coverage, payments, or a plan that provides coverage or payments for some or all contraceptive services based on their sincerely held religious beliefs or moral convictions. For this purpose, the term “contraceptive services” includes contraceptive or sterilization items, procedures, or services, or related patient education or counseling.
Exempt entities will not be required to comply with a self-certification process. However, where an exemption applies and all or a subset of contraceptive services are omitted from a plan’s coverage, otherwise applicable ERISA disclosures must reflect the omission of coverage in ERISA plans.
For more information on the interim final rules, please click here.
The IRS has released the final 2017 Instructions for Forms 1094-B, 1095-B, 1094-C, and 1095-C to help employers prepare for calendar year 2017 Affordable Care Act (ACA) information reporting. Employers will use the final versions of the forms and instructions in early 2018 to report on health coverage offered (or not offered) in the 2017 calendar year.
The 2017 instructions differ from the 2016 instructions as follows:
The following forms are now available for calendar year 2017 reporting:
The upcoming deadlines for submitting Forms 1094 and 1095 are as follows:
As a result of Hurricanes Harvey, Irma, and Maria, the Centers for Medicare & Medicaid Services (CMS) will make available special enrollment periods for certain individuals seeking health plans offered through the Federal Health Insurance Marketplace (Exchange). In general, these special enrollment periods are available to residents of Florida, Georgia, Louisiana, South Carolina, and Texas.
The special enrollment periods created by CMS will allow individuals impacted by the storms to select a new 2017 Marketplace plan or make changes to their existing 2017 plan at any time through December 31, 2017. Specifically, there will be special enrollment periods for individuals who:
These special enrollment opportunities are in addition to the annual open enrollment period this fall and any other enrollment period for which the individual may be eligible.
Additional details on these special enrollment periods can be found here.
Exercising is great for your body, but it is important to take care of yourself during and after your workout. You can do this is by staying hydrated and maintaining your blood sugar levels.
When you’re exercising, your body quickly absorbs blood sugars for energy. You also lose electrolytes, or minerals such as sodium and potassium, when you sweat. A good way to replenish your blood sugars and electrolytes is to drink sports drinks.
Most sports drinks offer a blend of sugars such as glucose, sucrose, fructose, and galactose. A few may also add maltodextrin, a complex carbohydrate made of several glucose units. Some research suggests that sports drinks offering a carbohydrate blend may improve the number of carbohydrates that eventually get to your muscles as fuel. Different sugars are absorbed in different ways, so the rate of carbohydrate absorption is improved by providing several different sugars.
Sports drinks also come with added electrolytes like sodium and potassium. Sodium, the electrolyte lost in the greatest amount, helps maintain fluid balance in the body and improves hydration.
With so many varieties available, selecting the right energy bar is anything but simple. To choose the best one for you, read the label. High-carbohydrate bars provide carbohydrate fueling both before and during a long workout. These bars typically provide about 70 percent of their calories from carbohydrates as sugars.
How quickly carbohydrates get into the circulation is referred to as the glycemic index. Eating a high glycemic index bar means a rapid release of carbohydrates into the bloodstream, giving the muscles a quick “shot” of fuel, which is ideal during a workout. Eating a low glycemic index bar results in a slower release of sugar into the circulation and sustained energy, which is best before exercise.
Keep in mind that many energy bars, particularly high-carbohydrate bars, are intended for people who spend an hour or more doing aerobic exercise like biking or running. The best way you can replenish your blood sugars, whether you’re exercising or not, is by eating a balanced diet full of fruits, vegetables, and whole grains.
This brochure is for informational purposes only and is not intended as medical advice. For further information, please consult a medical professional.
It is relatively inexpensive to include dental benefits in an employer’s benefits plan, and it may help the employer attract and retain highly skilled employees.
Because dental hygiene is associated with overall health, employees with dental plans are often healthier. Employees without dental benefits may postpone or forgo dentist visits in order to save money, and as a result, they can end up with more severe health problems. This may cost an employer more in the long run than if dental benefits were offered.
Various types of dental plans are available. An employer should select one that fits its budget and meets the needs of its employees. Besides traditional dental insurance plans such as managed care and fee-for-service, consumer-driven dental plans—such as dental flexible spending accounts—are becoming more popular.
Employers who are concerned about the cost of offering dental benefits may consider sharing the cost with employees through deductibles, coinsurance and by setting maximum amounts that the company will pay per individual in a specific time period. When designing a dental insurance plan, aim for a plan that is cost-effective and valuable to the company and its employees.
The decision to offer dental benefits is a business decision. Employers should consider their cultures and values as an organization and whether such benefits can help attract and retain valued employees. While dental benefits are an added expense, offering these benefits may save the employer money over time.
No. The ACA did not extend the eligibility time period for the COBRA premium reduction. Eligibility for the subsidy ended on May 31, 2010; however, those individuals who became eligible on or before May 31, 2010, could still receive the full 15 months as long as they remained otherwise eligible.
No. The ACA did not extend the maximum time periods of continuation coverage provided by COBRA. COBRA establishes required periods of coverage for continuation health benefits. A plan, however, may provide longer periods of coverage beyond those required by COBRA. COBRA beneficiaries generally are eligible for group coverage during a maximum of 18 months for qualifying events due to employment termination or reduction of hours of work.
Certain qualifying events, or a second qualifying event during the initial period of coverage, may allow a beneficiary to receive a maximum of 36 months of coverage.
Individuals who become disabled can extend the 18 month period of continuation coverage for a qualifying event that is a termination of employment or reduction of hours. To qualify for additional months of COBRA continuation coverage, the qualified beneficiary must:
If these requirements are met, the entire family qualifies for an additional 11 months of COBRA coverage.
No. The ACA did not eliminate COBRA or change the COBRA rules.
The ACA makes many changes to employee health benefit plans. Some of the changes took effect for the first plan year that began on or after six months after enactment (Sept. 23, 2010)—so, for calendar year plans, Jan. 1, 2011. Many of the ACA’s key reforms (for example, the prohibition on pre-existing condition exclusions for all enrollees) took effect for plan years beginning on or after Jan. 1, 2014.
Source: Department of Labor
The Affordable Care Act (ACA) requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements for the services.
Under the ACA, all health care plans must cover at least one prescription drug in every class/category of approved medications in the United States. Furthermore, any patient costs for medication must now be applied towards the policy holder’s annual out-of-pocket expenses.
With today’s increased focus on the importance of mental health, insurance plans must now offer coverage for mental and behavioral health services. Specific coverage varies from state to state, with some states requiring a set copay and others placing a cap on the number of approved therapy sessions per patient each year.
For both short and long-term rehabilitation from injuries and illnesses, the Affordable Care Act now requires insurance companies to provide coverage for therapy needed to help patients recover. This could include anything from medical equipment (canes and wheelchairs) to physical therapy sessions.
All preventative screenings, including pap smears for women and prostate exams for men, are now required to be covered under the ACA.
This was one of the major changes under the ACA, as many insurance plans did not offer this type of coverage in the past or if they did, charged more to include it as an additional rider. Today, all plans are required to cover prenatal care, childbirth, and infant care following delivery.
In addition to newborn care, children under the age of 19 will also be entitled to teeth cleanings, X-rays, and other basic medical/dental care under the ACA.
As a result of the ACA, many insurance plans provide coverage for a range of preventative services and may not charge a copayment, deductibles, or coinsurance to patients receiving preventative care. Preventative care includes medical tests, immunizations, screening labs, preventative medications and other services that would prevent disease.
Insurance companies must now cover hospitalization for serious medical issues under the new law. However, policyholders should review their policies carefully, as they may still be required to meet their annual out-of-pocket maximums before this coverage will kick in.
In the event of a medical emergency, the ACA mandates you cannot be charged extra for seeing an out-of-network provider and that you no longer need pre-authorization to visit an emergency room.
Most plans already provide coverage for outpatient care, but the ACA has made coverage minimums, including network sizes, much more strict.
Compliance with the complex rules regarding COBRA coverage can be difficult and mistakes can be costly. Penalties for non-compliance can include IRS excise taxes and ERISA statutory fines. See below for some of the most common mistakes benefit administrators make when it comes to COBRA:
1. Bad Timing
In the context of COBRA, paying attention to the timing of providing coverage can be crucial for reducing exposure to COBRA costs and being compliant with the rules. The duration of COBRA coverage is controlled by the COBRA statute. Complying with these rules by providing the length of coverage required is important. At the same time, many plan sponsors want to minimize the likelihood of being responsible for large claims by COBRA QBs by only providing the minimum duration of coverage.
The period of COBRA coverage offered to QBs is known as the “maximum coverage period.” The length of the maximum coverage period depends on the type of qualifying event that has occurred. The maximum coverage period is 18 months for a termination of employment or reduction in hours and 36 months for all other qualifying events. There are situations where the maximum coverage period can be extended or terminated early.
2. No Documentation
No matter how good your COBRA compliance track record is, you can still run into trouble if you can’t prove it. Adequate documentation is important because it brings together all other elements of COBRA administration and compliance. Having thorough and accurate records will help streamline administration and support the plan in the event of a claim.
There are many different areas where documentation can help avoid COBRA compliance issues. For example, a plan’s COBRA notice information and procedures can be documented in the SPD and notice documents themselves, as well as the plan document if necessary. A plan administrator should also keep records of notices sent to and received from participants and QBs. Keeping track of payments received from QBs and made to insurers, as well as the deadlines for payments, will also assist in the proper administration of COBRA coverage.
3. Charging too Much (or not enough)
A health plan may charge COBRA QBs for the cost of providing COBRA coverage. It may require QBs to pay up to 102% of the “applicable premium” for the plan. In the case of a disability extension, it may charge up to 150% of the applicable premium for certain QBs. The applicable premium is the cost to the plan of providing coverage. For insured plans, the applicable premium is usually equal to the insurance premium paid to the insurance carrier. However, the calculation can be more difficult for self-funded plans and can be determined using past costs or an actuarial estimate of future costs. The applicable premium is the total cost to the plan for providing coverage, so it includes both employer- and employee-paid portions and can also include the administrative cost of providing COBRA coverage.
The plan must calculate the COBRA applicable premium in advance for a 12-month “determination period.” The plan can choose any 12-month period to be the determination period, but it must remain consistent every year. The COBRA premium may be changed for a new determination period if the applicable premium changes and there are certain limited situations where the COBRA premium may be changed during the determination period (for example, if the QB changes coverage to another benefit package with a higher applicable premium).
The plan administrator should use caution in calculating the COBRA premium as well as in communicating that premium to QBs. Fixing mistakes that result in over- or undercharging QBs for COBRA premiums can be administratively burdensome and raise COBRA compliance issues.