DOL has issued the FAQs about Affordable Care Act Implementation Part XXIII (FAQs have been prepared jointly by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments)) The Departments have become aware of health insurance issuers selling
How Employers Should Handle MLR Rebates
The Affordable Care Act (ACA) requires health insurance issuers to spend a minimum percentage of their premium dollars on medical care and health care quality improvement. This percentage, or medical loss ratio (MLR), is 85 percent for issuers in the large group market and 80 percent for issuers in
Health Care Reform: Exchange Notices – Reminder
The ACA requires employers to provide all new hires and current employees with a written notice about the ACA’s Exchanges, which the Department of Labor (DOL) calls the “Notice to Employees of Coverage Options.” This requirement is found in Section 18B of the Fair Labor Standards Act (FLSA).
New Proposed Regulations for Summary of Benefits and Coverage (SBC)
On Dec. 22, 2014, the U.S. Departments of Health and Human Services, Labor and the Treasury (Departments) released proposed regulations regarding the summary of benefits and coverage (SBC). The proposed regulations would amend the final SBC regulations from Feb. 14, 2012. Also released were a
Documenting Method for Identifying Full-time Employees
Beginning in 2015, the Affordable Care Act (ACA) imposes a penalty on applicable large employers (ALEs) that do not offer health insurance coverage to substantially all full-time employees and dependents. An ALE may also be subject to a penalty if it offers health insurance coverage to full-time
DOL Audit Warning Signs
The Department of Labor (DOL)’s Employee Benefits Security Administration (EBSA) has the authority to conduct audits on benefit plans that are governed by the Employee Retirement Income Security Act (ERISA). DOL audits often focus on violations of ERISA’s fiduciary obligations and reporting and
ACA’s Affordability Percentages
The affordability of health coverage is a key point in determining whether an ALE (Applicable Large Employer) will be subject to a penalty. The pay or play rules generally determine affordability of employer-sponsored coverage by reference to the rules for determining premium tax credit
HIPAA Certificates No Longer Required in 2015
Effective for plan years beginning on or after Jan. 1, 2014, the Affordable Care Act (ACA) prohibits group health plans and issuers from imposing pre-existing condition exclusions (PCEs) on any enrollees. Prior to 2014 plan years, the ACA prohibited PCEs for enrollees under 19 years of age. The