Infographic: Understanding the Individual Health Insurance Tax Subsidies

Post by: Butch Zemar in Uncategorized

Infographic: Understanding the Individual Health Insurance Tax Subsidies

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29 July 2013
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HIPAA 5010 and ICD-10

Post by: Butch Zemar in Uncategorized

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 Administra...

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28 July 2013
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Small Business Tax Credit

Post by: Butch Zemar in Uncategorized

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 t...

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27 July 2013
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Pre-Existing Conditions - Healthcare Reform

Post by: Butch Zemar in Uncategorized

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 becom...

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27 July 2013
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Dependent (Adult Child) Coverage

Post by: Butch Zemar in Uncategorized

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' ta...

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27 July 2013
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Annual Limits on Health Insurance

Post by: Butch Zemar in Uncategorized

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, 2...

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26 July 2013
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FSA/HSA/HRA Changes

Post by: Butch Zemar in Uncategorized

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, 201...

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26 July 2013
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Taxes and Fees - Healthcare Reform

Post by: Butch Zemar in Uncategorized

Review Taxes and Fees - Healthcare Reform

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25 July 2013
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Health Benefit Exchanges

Post by: Butch Zemar in Uncategorized

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 ...

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25 July 2013
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Individual Mandate

Post by: Butch Zemar in Uncategorized

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 insur...

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24 July 2013
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Medicare Part D Drug Coverage

Post by: Butch Zemar in Uncategorized

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 $...

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24 July 2013
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Essential Health Benefits

Post by: Butch Zemar in Uncategorized

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 ...

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23 July 2013
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Patient-Centered Outcomes Research Institute Fee

Post by: Butch Zemar in Uncategorized

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 co...

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23 July 2013
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Adjusted Community Rating

Post by: Butch Zemar in Uncategorized

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 ...

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22 July 2013
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Administrative Simplification: Eligibility and claim status

Post by: Butch Zemar in Uncategorized

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 ope...

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22 July 2013
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Small Business Health Insurance - What Do Employees Want?

Post by: Butch Zemar in Uncategorized

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 Em...

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21 July 2013
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Video: Obamacare - Glitch in System Could Favor Smokers

Post by: Butch Zemar in Uncategorized

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.

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20 July 2013
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Video: The Obama Administration Delays a Major Section of Obamacare

Post by: Butch Zemar in Uncategorized

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.

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19 July 2013
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Obamacare: Glitch in System Could Favor Smokers

Post by: Butch Zemar in Uncategorized

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 smo...

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18 July 2013
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Four Things You Should Know About the Employer Mandate Delay

Post by: Butch Zemar in Uncategorized

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 e...

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17 July 2013
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