Government Resources
GOVERNMENT RESOURCES
Comprehensive health care reform (PPACA) was enacted with the passage of two new laws: the Patient Protection and Affordable Care Act (HR 3590), signed into law on March 23, 2010 and the Health and Education Affordability Reconciliation Act of 2010 (HR 4872), signed on March 30, 2010.
Government Agency Web Sites
Tax Reporting (Forms W-2, 1099, etc.)
The IRS has issued Notice 2010-69 which provides interim relief to employers with respect to reporting the cost of coverage under an employer-sponsored group health plan on Form W-2, Wage and Tax Statement. Reporting the cost of such coverage will not be mandatory for Forms W-2 issued for 2011. The IRS has determined that this relief is appropriate to provide employers with additional time to make any necessary changes to their payroll systems or procedures in preparation for compliance with the reporting requirement. The IRS is planning to release additional guidance on this reporting requirement before the end of the year.
The IRS confirms that the requirement to report the value of health benefits on Form W-2 does NOT mean that health benefits will be taxable.
Nondiscrimination Rules for Insured Group Health Plans
The IRS has released
Notice 2011-1 which delays compliance with nondiscrimination rules for insured health plans until further guidance is released. The notice also requests additional public comments on specific concerns with these rules until March 11, 2011.
12/22/10 (New!) The IRS has issued
Notice 2010-63 to solicit public comments concerning the application of rules prohibiting insured group health plans from discriminating in favor of highly compensated individuals. Comments are due by November 4, 2010.
9/20/10
Health Care Accounts and Over-the-Counter Drugs
The IRS has issued Notice 2011-5 which provides guidance on use of health FSA and HRA debit cards to purchase over-the-counter medicines or drugs that are prescribed. 12/23/10 (New!)
The IRS has released guidance revising the definition of medical expenses, specifically for over-the-counter drugs, for employer-provided accident and health plans, including health flexible spending arrangements (health FSAs), health reimbursement arrangements (HRAs), Health Savings Accounts (HSAs) and Archer Medical Savings Accounts (Archer MSAs).
Health Insurance Exchanges
The Health Insurance and Managed Care Committee of the National Association of Insurance Commissioners (NAIC) has approved the American Health Benefit Exchange Model Act, designed to aid states in establishing health insurance exchanges. The model act must be approved by the full NAIC before being recommended for states to adopt.
On July 29, 2010, HHS announced the availability of grants to help states begin work to establish health insurance exchanges. HHS also is requesting public input on developing standard for the exchanges.
Group Health Plan Coverage of Preventive Services
The agencies have issued a request for information on how group health plans and health insurance issuers can employ value-based insurance design in the coverage of recommended preventive services. Public comments in response to this request for information are due on or before February 28, 2011. 12/28/10 (New!)
On July 14, 2010, the EBSA, IRS and OCIIO released interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding preventive health services. These rules spell out the requirements for health plans to cover preventive services without employee/participant cost sharing. These rules do not apply to grandfathered plans. The regulations are expected to be published in the July 19, 2010 edition of the Federal Register. These interim final regulations will be effective 60 days after publication in the Federal Register and public comments will be accepted until the effective date.
Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections
HHS's OCIIO has released new guidance that will give consumers more information about their health insurance plan. Under the new rules, health insurers offering “mini-med” plans must notify consumers in plain language that their plan offers extremely limited benefits and direct them to www.HealthCare.gov where they can get more information about other coverage options. HHS has also issued guidance restricting the sale of new mini-med plans except under very limited circumstances.
The OCIIO has issued additional guidance to clarify the waiver process. This guidance addresses who can apply for a waiver and whether some similar process might be available with respect to the medical loss ratio (MLR) provisions of the Affordable Care Act with respect to mini-med plans.
The OCIIO has released guidance on obtaining a waiver of the restricted annual limits required by the health care reform law. The regulations on annual limits provided that these restrictions may be waived by the Secretary of Health and Human Services if compliance with the interim final regulations would result in a significant decrease in access to benefits or a significant increase in premiums. This guidance is especially relevant to limited benefit/mini-med plans.
The EBSA, IRS and OCIIO have released interim final rules to implement the health care reform provisions related to preexisting condition exclusions, lifetime and annual limits, rescissions, and patient protections. These regulations are effective on August 27, 2010.
The HHS, EBSA and IRS have released an amendment to the interim final rules relating to the specifications of grandfathered status for group health plans and health insurance coverage. The amendment allows group health plans to change insurers without losing grandfathered status so long as the structure of the coverage doesn’t violate one of the other rules for maintaining grandfathered plan status. The amendment is effective November 15, 2010.
The HHS, EBSA and IRS have released interim final regulations that outline what is required to maintain grandfathered health plan status under the Patient Protection and Affordable Care Act.
- Interim Final Rules, 6/17/10
- Summary Chart, 6/28/10
- Fact Sheet, HHS, 6/14/10
- FAQs, HHS, 6/15/10
- Table of Provisions Applicable to Grandfathered Plans, EBSA, 6/17/10
- Model Disclosure Notice, EBSA, 6/17/10
Coverage for Adult Children Up to Age 26 and Tax Benefits Up to Age 27
The EBSA, IRS and HHS have released regulations and explanatory aids on the health care reform provisions for coverage of adult children up to age 26.
The recently enacted Affordable Care Act allows health coverage provided for an employee's children under 27 years of age to be generally tax-free to the employee, effective March 30, 2010. The Internal Revenue Service (IRS) has announced that these changes immediately allow employers with cafeteria plans to permit employees to begin making pre-tax contributions to pay for this expanded benefit.
Reinsurance Program for Early Retirees (ERRP)
HHS has announced that Plan Sponsors with an approved application are now able to Report Costs and Request Reimbursement in the Early Retiree Reinsurance Program (ERRP) Secure Website (SWS). Plan Sponsors must report costs before requesting reimbursement. 10/23/10
HHS has announced an additional 1,000 applicants accepted into the Early Retiree Insurance Program. These applicants are in addition to the 2,000 applicants accepted in August. HHS has provided a full alphabetical list of participants and an interactive map displaying participants by state online. Going forward, this list will be updated every Friday. 10/4/2010
HHS has issued more guidance clarifying which claims are eligible for reimbursement under the ERRP. Claims Ineligible for Reimbursement Under the Early Retiree Reinsurance Program, 9/28/2010
Procedure Codes Ineligible for Reimbursement, 10/19/10
On September 17, 2010, HHS released new guidance on two key ERRP reimbursement preparation steps including accessing the ERRP Secure Website system and identifying the source(s) that will send the early retiree data required to receive ERRP reimbursements. HHS issued additional information on how to identify early retirees on September 24, 2010.
Also, the HHS has announced the creation of a new Web site that brings together all the relevant information on the Early Retiree Reinsurance Program.
The HHS Office of Consumer Information and Insurance Oversight (OCIIO), announced that applications were accepted starting June 29, 2010. Also, the OCIIO has posted the official version of the application and its instructions.
HHS published an interim final rule with comment period that implements the Early Retiree Reinsurance Program. Congress appropriated funding of $5 billion for the temporary program. The program is scheduled to begin in June 2010 and ends no later than January 1, 2014. It provides reimbursement to participating employment-based plans for a portion of the cost of health benefits for early retirees and their spouses, surviving spouses and dependents. 5/4/10
Health Care Reform Insurance Web Portal Requirements
The HHS unveiled its on-line tool, HealthCare.gov, to help consumers connect to new information and resources that will help them access affordable health care coverage. 7/1/10
Small Business Tax Credits
The IRS has released final guidance for small employers eligible to claim the new small business health care tax credit for the 2010 tax year. The release includes a one-page form and instructions small employers will use to claim the credit for the 2010 tax year.
The IRS issued Notice 2010-44 that provides detailed guidance, including examples, to help small employers determine whether they qualify for the credit and estimate the amount of the credit. Press Release 5/17/10
The IRS has created a video explaining the small business health care tax credit. 4/23/10
The IRS has issued a press release announcing available guidance on the new tax credits available to small businesses and tax-exempt organizations that provide health insurance coverage to their employees. 4/1/10
Insurance Premium Rate Review
HHS issued proposed regulations to allow HHS to work with states to require insurers to publicly disclose and justify unreasonable rate increases.
HHS issued a news release on the grant awards of $46 million to states to promote improvements in the oversight of health insurance premium increases and take action against insurers who raise premiums unreasonably. 8/16/10
HHS announced in a news release the availability of $51 million in Health Insurance Premium Review Grants through the Affordable Care Act. These funds are the first round of grants available to states through a new grant program to create and strengthen insurance rate review processes. 6/7/10
Temporary High Risk Pool/ Preexisting Condition Insurance Plan
Starting in 2011, HHS is offering more coverage options under the Pre-existing Condition Insurance Plan (PCIP). 11/5/10
HHS has released an interim final rule detailing features of the Pre-existing Condition Insurance Plan (PCIP). Issues addressed in the regulations include premiums charged, eligibility, program funding and benefits provided. The program is temporary and will last until 2014 when discriminating against anyone with a preexisting condition will be illegal. These rules take effect on July 30, 2010.
HHS announced that pharmaceutical manufacturers will provide 50 percent discounts on the cost of covered brand-name prescription drugs for beneficiaries in the Medicare Part D coverage gap, or donut hole, starting in 2011. 9/23/10
Breaks for Nursing Mothers
The Wage and Hour Division of the Department of Labor has issued a request for information (RFI) regarding the requirement that employers provide reasonable break time and a place for nursing mothers to express breast milk for one year after child birth. Contained in the RFI are the Department's preliminary interpretations of the new break time amendment to the Fair Labor Standards Act. 12/21/10 (New!)
Adoption Credit Expansion
The IRS issued guidance on the expanded adoption credit included in the PPACA. The IRS also released a draft version of the form that eligible taxpayers will use to claim the newly-expanded adoption credit on 2010 tax returns filed next year. PPACA raises the maximum adoption credit to $13,170 per child and makes the credit refundable.
COBRA and Health Care Reform
The EBSA has created an FAQ web page to address questions concerning the effect of the health reform laws on COBRA. 4/16/10