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Infographic: Understanding the Individual Health Insurance Tax Subsidies

Summary The Administrative Simplification provision of the Patient Protection and Affordable Care Act of 2010 (the Act) requires covered entities – health plans, health care clearinghouses and providers – to upgrade to new standards in electronically conducting certain administrative transactions. Two of the key building blocks to achieve Administrative Si...

Summary Certain small businesses that offer health benefits are now eligible for health care tax credits. These vary depending on the tax-exempt status of the organization and employer contribution toward health benefits. Eligible employers must pay at least half the cost of single coverage for their employees. There must be no more than 25 fu...

Summary Beginning Sept. 23, 2010, group health plans cannot exclude enrollees (employees, spouses or dependents) under age 19 based on pre-existing conditions. For other plans, all pre-existing condition exclusions must be removed beginning in 2014. Grandfathered group health plans receive no special protection and must comply once the provision becomes ef...

Summary Plans that provide coverage for dependents are required to extend the coverage of dependents (adult children) to age 26, regardless of their eligibility for other insurance coverage, effective Sept. 23, 2010. Plans must provide coverage to all eligible dependents, including those who are not enrolled in school, not dependents on their parents' tax r...

Summary The provision restricts annual limits on the dollar value of Essential Health Benefits. Annual limits may not be less than the following amounts. For plan years beginning before Jan. 1, 2014: $750,000 on or after Sept. 23, 2010 $1.25 million on or after Sept. 23, 2011 $2 million on or after Sept. 23, 2012 to Jan. 1, 2014 These r...

Summary Beginning Jan. 1, 2011, over-the-counter (OTC) medications are no longer eligible for reimbursement from a Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Account (HRA) unless obtained with a prescription. Also in 2011, the excise tax for non-qualified HSA withdrawals doubles to 20%. Beginning Jan. 1, 2013, em...

Review Taxes and Fees - Healthcare Reform

Summary The Patient Protection and Affordable Care Act (PPACA) requires each state to establish an American Health Benefit Exchange (including a Small business Health Options Program (SHOP) exchange), by Jan. 1, 2014. In 2014-2016, only individuals and small group employers are eligible to participate in the Exchange; beginning in 2017, states may permit...

Summary Beginning in 2014, the health reform law requires most individuals to have health insurance for themselves and their spouses or dependents. The requirement is for each individual to have MEC or pay a potential penalty for noncompliance. Coverage may be obtained through government programs such as Medicare or Medicaid; employer or individual insuranc...

Summary The Patient Protection and Affordability Act addresses the gap in coverage Medicare Part D enrollees experience when they exceed the initial coverage limit of $2,840. Prior to 2011, most* Medicare Part D enrollees were required to pay 100 percent of prescription drug costs once expenses exceeded the initial coverage limit and until they reached $4,5...

Summary The Act defines certain categories of benefits as "Essential Health Benefits." The categories of essential health benefits are: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription...

Summary The Patient Protection and Affordable Care Act (the Act) imposes a new Patient-Centered Outcomes Research Institute (PCORI) fee, formerly the comparative effectiveness research fee, on plan sponsors and issuers of individual and group policies. The first year of the fee is $1 per covered life per year, the second year the fee adjusts to $2 per cover...

Summary On Feb. 22, 2013, the U.S. Department of Health and Human Services (HHS) issued a final rule to implement the Affordable Care Act's (ACA) fair health insurance premium (adjusted community rating), guaranteed availability (issue), guaranteed renewability, single risk pool, catastrophic plans and rate review provisions. The final rule clarifies and a...

Summary The Administrative Simplification provision under Section 1104 of the Patient Protection and Affordable Care Act (the Act) intends to improve the standards for electronic transactions mandated by the Health Insurance Portability and Accountability Act (HIPAA). The intent of this provision is to reduce administrative costs by adopting a set of operat...

What do small business employees want from health insurance? What keeps them loyal and motivated to stay with the business? How should a small business design their health insurance offerings to match what employees value? Metlife recently surveyed small businesses and employees about these questions, and reported survey findings in the 2013 Study of Employ...

Yet, another delay in the healthcare overhaul due to a glitch in the system last week involving the healthcare law. This means smokers may get at least some relief next year from tobacco use penalties.  A fix will take at least a year.

Employer Mandate was delayed until 2015 by the Obama Administration.  This is good news for some employers.  It could question the integrity of the law as we move forward as far as how much will actually stick.

Yet, another delay in the healthcare overhaul due to a glitch in the system last week involving the healthcare law. This means smokers may get at least some relief next year from tobacco use penalties. A fix will take at least a year. Due to the system limitation, the system cannot currently process premiums for a 65-year-old smoker that is o...

On July 2, 2013 the Department of the Treasury and the White House used their blogs to announce that the employer reporting requirements, and the employer shared responsibility/play or pay penalty, are being delayed until 2015.  The Treasury said that it will provide a formal announcement and additional details next week. In the meantime, UBA's experts...