The Department of Health and Human Services (HHS) published on March 11, 2014 the final rule on benefit and payment parameters for 2015. This rule includes oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs as well as cost-sharing parameters and cost-sharing reductions.
In this rule, HHS finalized its provision that any self-insured group health plan that does not use a third party administrator for claims processing, adjudication, or plan enrollment for the 2015 and 2016 benefit years is excluded from making reinsurance contributions.
Cost-sharing limits for calendar year 2015 will be increased from $6,350 to $6,600 for self-only coverage. The limits for all other coverage will be increased from $12,700 to $13,200 for 2015.
These regulations are effective on May 12, 2014.
The Internal Revenue Service (IRS) issued proposed regulations addressing the individual shared responsibility payment provisions of the Affordable Care Act. Beginning January 1, 2014, individuals are required to maintain minimum essential health coverage or pay a penalty known as a shared responsibility payment unless the individual qualifies for an exemption. Continue reading
The IRS has issued proposed regulations on two separate reporting requirements under the Affordable Care Act. Tax penalties may be enforced for failure to comply unless the failure is due to reasonable cause and not willful neglect. Both of the requirements have been delayed for one year with the first reports due in 2016 for the 2015 calendar year.
The regulations under section 6055 of the Internal Revenue Code impose new reporting requirements on health insurers, sponsors of self-funded group health plans, and others who provide individuals with minimum essential health coverage. These health benefit providers must provide a report to the IRS and a statement to enrolled individuals containing specific information which will be used to administer the individual mandate. The information will be on a monthly basis even though the report will be prepared on an annual basis.
The regulations under section 6056 require large employers (more than 50 full-time employees or full-time equivalents) to provide a report to the IRS and a statement to all full-time employees containing information about the employer-provided coverage that is offered, even if the individual is not enrolled in the coverage. This information will then be used to administer the employer mandate. This report also contains monthly information but is reported on an annual basis. The IRS will also use this report to administer the premium tax credit under section 36B of the Internal Revenue Code.