Here is some great information for 2013 – 2014 rules from the government on the PPACA / ACA / new health care laws. This information below is more for group insurance / employer health care insurance than it is for individuals/family coverage.
| Summary of Benefits and CoveragePursuant to PPACA, health insurance issuers and group health plans must provide consumers with an easy-to-understand summary of a plan’s benefits and coverage (SBC). SBCs must be provided to consumers and enrollees at important points in the enrollment process, including upon application and at renewal. Consumers also may request a copy from the issuer or group health plan. A recently updated template is available online.On April 23, 2013, the Departments of Labor, Health and Human Services, and the Treasury issued a set of Frequently Asked Questions about SBCs. Notably, the departments emphasized assisting (as opposed to imposing penalties on) plans, issuers, and others in complying with the new law. In this guidance, the departments extended certain SBC-related safe harbors and other enforcement relief through the second year of applicability. |
| Summary Plan DescriptionUnder the Employee Retirement Income Security Act (ERISA), employer-provided group health plans must provide plan participants with a written summary plan description (SPD) describing participants’ rights, benefits, and responsibilities under the plan.Specifically, the SPD details when an employee can begin to participate in the plan, how service and benefits are calculated, when benefits become vested, when and in what form benefits are paid, and how to file a claim for benefits. Plan administrators must give each participant an SPD within 90 days after he or she becomes covered by the plan or within 120 days after the plan is first subject to the reporting and disclosure provisions of ERISA. If there are material changes to the plan, the plan administrator must give participants a summary of material modifications within 210 days from the end of the plan year in which the changes were made.However, if the change is a material reduction in covered services or benefits, the summary must be furnished within 60 days after the reduction is adopted. Moreover, participants or beneficiaries may request a copy of the SPD and any summaries of material modifications at any time, which must be provided within 30 days of a written request. |
| W-2 Reporting RequirementsIn order to provide information to employees on the cost of their health care coverage, PPACA requires employers that provide “applicable employer-sponsored coverage” under a group health plan to report the cost of coverage on an employee’s W-2 form. Entities subject to this reporting requirement include businesses, tax-exempt organizations, and federal, state and local government entities. The Internal Revenue Service (IRS) has clarified that the amounts reported are not taxable and this reporting is for informational purposes only.Only employers who filed at least 250 W-2 forms in the previous calendar year will be subject to the W-2 reporting requirement for the current calendar year. Transition relief is also available to certain other employers and types of coverage until the IRS publishes additional guidance. Generally, the amount reported should include both the portion paid by the employer and the portion paid by the employee. Employers are responsible for determining each employee’s cost of coverage and which employees should receive the information. To learn more about the employers and types of coverage that are subject to this reporting requirement, view the chart available on the IRS website. |
| Annual Federal Reporting RequirementsPPACA added section 6055 of the Internal Revenue Code, which requires health insurance issuers, government agencies, employers that sponsor self-insured plans, and other entities to file annual returns reporting information for each individual for whom the entity provides “Minimum Essential Coverage” – a term that includes health insurance coverage offered in the individual market, an eligible employer-sponsored plan, or government-sponsored coverage.Information returns must include identification of covered individuals, dates of coverage, whether the coverage is a qualified health plan offered through an Exchange (also referred to as a Marketplace), and the amount (if any) of the premium tax credit or cost-sharing reduction. Moreover, information returns for Minimum Essential Coverage provided by a health insurance issuer through an employer’s group health plan must also include identification of the employer and the portion of the premium to be paid by the employer.Additionally, under section 6066 of the Internal Revenue Code, large employers subject to the employer shared responsibility requirements must file annual reports with the IRS on the terms and conditions of their health care coverage for full-time employees. This return must also include information on the employer’s full-time employees, including those who received the coverage and when they received it.In Notices 2012-32 and 2012-33, the IRS requested comments on regulations implementing these reporting requirements while minimizing administrative burden and duplicative reporting.
Note: These reporting requirements have been delayed by federal rule until 2015. These requirements are subject to change pending a new rule from the Department of Health and Human Services. |
