Health Care Reform

Navigating Health Care Reform

As the Affordable Care Act (ACA) continues to evolve, understanding and complying with federal mandates can be a complex and potentially costly endeavor.  With Marsh & McLennan Agency, you have peace of mind knowing that our team of experts is constantly monitoring and analyzing the reform and the implications for your business.  Our local team, backed by the resources of the industry experts of Marsh & McLennan Agency, is here to help you navigate today and prepare for the future. 

Scope of Services

Based on the needs of your organization, we provide the following services:

  • Analysis of your current plans to determine if you are at risk of triggering penalties for non-compliance, shared responsibility, surcharges or the excise tax
  • Identification of key risk elements and offering of solutions for potential issues
  • A complete reform 'checkup' to make certain you comply with all aspects of regulation
  • An understanding of the financial impact of reform to your business
  • Strategic recommendations to help you better manage your employee benefit plans
  • The ability to help you manage and contain costs associated with ACA
  • Assist with development of employee communication strategies to minimize confusion

Regardless of your industry, size or location, our experts partner with you to understand your long-term plans and needs.  Our team works with you to develop strategies to help you achieve your goals in light of future regulations and reforms.

Resource Center

Welcome the Marsh & McLennan Agency Health Care Reform Resource Center. Included here you will find timely alerts, briefs and resources designed to keep you updated on all the latest Health Care Reform news. MMA is committed to keeping clients informed so they can better prepare for how the law impacts their business and bottom line.

In addition to the Resource Center, MMA has also launched a microsite dedicated to providing employers with the tools and resources  needed to prepare for the changes ahead.  Click here to visit the site and learn more . 

Alerts and Briefs:

Supreme Court Rules on King v Burwell
In a 6-3 holding released today the United States Supreme Court upheld the availability of subsidies in exchanges maintained by the federal government. Six members of the Court - Chief Justice Roberts, Justices Kennedy, Ginsburg, Breyer, Sotomayor and Kagan voted to validate the Internal Revenue Service's interpretation of the Affordable Care Act ("ACA") that permits premium tax credits in both state- and federally-operated exchanges. This means two things: (i) some 7.5 million Americans will not lose their subsidies that help them to pay for health insurance and (ii) it is back to "business as normal" for the ACA - meaning all employers must continue to attend to their compliance efforts.

IRS Releases Final Forms and Instructions for Affordable Care Act Reporting
In February 2015, the IRS released final forms and instructions related to information reporting under the Affordable Care Act (the "ACA"). These forms include Form 1095-B, Health Coverage, Form 1094-B, Transmittal of Health Coverage Information Returns, Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, and Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage.

New HHS Regulations "Clarify" that Health Plans Covering Families Must Have "Embedded" Individual Cost-Sharing Limits
On February 27, 2015, the Department of Health and Human Services (HHS) released its final HHS Notice of Benefit and Payment Parameters for 2016. The lengthy regulation covers a wide range of topics affecting group health plans, including minimum value, determination of the transitional reinsurance fee, and qualified health plan rates and other market reforms applicable to the group and individual insurance markets.

IRS Releases First Guidance on ACA's So-Called "Cadillac Tax"
Last week, the IRS released Notice 2015-16 in an effort to begin developing regulatory guidance for the Affordable Care Act's excise tax on high-cost health coverage (the "Excise Tax"), which will become effective beginning as early as 2018. The Excise Tax, which is commonly referred to as the "Cadillac Tax," imposes a 40% nondeductible excise tax on the aggregate cost of an applicable employer-sponsored coverage (including employer-sponsored group health plan and multiemployer plan coverage) in excess of certain statutory limits. Although the Notice does not provide any definitive answers to the many questions raised, it is still welcome news in that it identifies a number of issues that could be addressed in forthcoming guidance and, in some cases, indicates the direction in which the IRS is headed. This can help many employers and plan sponsors as they now consider steps to mitigate possible exposure to the Excise Tax. This is especially true for employers contributing to multiemployer health plans who bargain benefit levels, as they may have only one more opportunity at the bargaining table to adjust benefits before the Excise Tax applies.

Transitional Reinsurance Fee Reporting Extended
On Friday, November 14, CMS extended the November 17, 2014 deadline for contributing entities (employers with self-insured medical plans) to submit their 2014 enrollment counts for the transitional reinsurance program. The deadline has been extended until 11:59 p.m. on Friday, December 5, 2014. The January 15, 2015 and November 15, 2015 payment deadlines remain the same. As a reminder, employers that sponsor self-insured major medical plans must report their annual enrollment count to the U.S. Department of Health and Human Services via the website by December 5, 2014, as part of the ACA's transitional reinsurance program.

IRS to Close Loophole on Sub-Standard Plans without Hospitalization or Physician Services Coverage
On November 4, 2014, the Internal Revenue Service (IRS) announced that it intends to close a perceived "loophole" in health care reform. This so-called loophole allows employers to offer low cost health plans that don't cover inpatient hospitalization services or physician services (or both). If that coverage were treated as minimum value coverage, then employers could avoid all pay-or-play penalties with low cost coverage and covered individuals would not be able to benefit from premium assistance or subsidies in the health insurance Marketplace.

CMS Announces Delayed Enforcement of HPID Requirement
On October 31st, CMS announced that it is delaying "until further notice" its enforcement of the regulation requiring health plans and other HIPAA-covered entities to obtain and use health plan identifiers (HPIDs). The full announcement can be found using the link below. This means that employers and other sponsors of self-insured group health plans will not be required to obtain an HPID by November 5, 2014.

IRS Increases Maximum Employee Contribution to Health Care FSAs for 2015
The IRS announced late last week that the maximum annual employee contribution to a health care flexible spending account plan is increasing by $50 to $2,550 for 2015 (up from the $2,500 limit that has applied since 2013).

Reminder: Transitional Reinsurance Fee Reporting for Self-Insured Medical Plans Due Nov. 15, 2014
As a reminder, employers with self-insured major medical plans must report their membership count to the U.S. Department of Health and Human Services via the website by November 15, 2014, as part of the Affordable Care Act's (ACA) transitional reinsurance fee (TRF).

Your ACA Preparation Tool
To help employers with the challenges of the Affordable Care Act, MMA has introduced a new ACA preparation tool. learn more..

IRS Releases the Adjusted Patient-Centered Outcomes Research Fee
The Internal Revenue Service (IRS) recently released the adjusted Patient-Centered Outcomes Research (PCOR) fee. The PCOR fee is assessed against group health plans. Insurance carriers are responsible for submitting the fee on behalf of their insured clients. Employers need to pay the fee for their self-funded plans. Self-funded employers pay the fee by submitting a Form 720.

Updated HPID Reminder: Health Plans Required to Register by November 5, 2014
As part of the Affordable Care Act's (ACA) Administrative Simplification provision, all controlling health plans (defined below) must obtain a 10-digit numeric identifier known as a Health Plan Identifier, or HPID. The HPID is part of a project that federal agencies, health insurers and health care provider groups have been working on for years, as final rules for the HPID requirement were published in the Federal Register on September 5, 2012 (77 FR 54719) (the Final Rules).

IRS to Amend Cafeteria Plan Regulations to Facilitate Enrollment in Marketplace Coverage
On Thursday, September 18, 2014, the Internal Revenue Service (IRS) released Notice 2014-55, which expands the cafeteria plan "change in status" rules to allow plans to offer employees an option to revoke their elections for employer-sponsored health coverage to purchase a qualified health plan through a Health Insurance Marketplace (Marketplace). The notice is effective immediately and will appear in IRB 2014-41, to be published Oct. 6, 2014.

IRS Increases 9.5% Affordability Threshold - Or Did It?
On July 24, 2014, the Internal Revenue Service (IRS) released three Revenue Procedures (2014-46, 2014-37, and 2014-41), which provide guidance to individuals on their obligation to maintain minimum essential coverage (MEC) under the Affordable Care Act ACA) so-called individual mandate. It has been widely reported that the IRS has increased the affordability percentage. This is not necessarily true.

IRS Releases Draft ACA Reporting Forms for Employers and Insurance Issuers
On Thursday, July 24, 2014, the Internal Revenue Service (IRS) released draft forms that applicable large employers and health insurance issuers will use to report information regarding health coverage, as required under the Affordable Care Act (ACA) starting in 2015. (The first reporting will be due in the first quarter of 2016, reflecting the 2015 calendar year.)

Court of Appeals Rule on Treatment of Subsidy Eligibility
July 22, 2014 marked a day when two different federal courts came out on opposite sides of the same question. In the morning, the U.S. Court of Appeals for the DC Circuit dealt a serious blow to the Obama Administration with a decision that called into question the structural integrity of the "pay-or-play" mandates under the Affordable Care Act ("ACA"). Later in the day, the U.S. Court of Appeals for the Fourth Circuit, sitting down the road in Richmond, came out on the other side of the question.

Your Employer Mandate Decision Tree

Supreme Court Sides with Employers and not Administration in Hobby Lobby
In a 5-4 decision announced June 30, 2014 in Burwell v. Hobby Lobby Stores, Inc. ("Hobby Lobby") (f/k/a Sebelius v. Hobby Lobby Stores, Inc.), the United States Supreme Court (the "Court") ruled that the federal government erred in requiring for-profit, faith-based employers to pay for certain forms of birth control that contradicted their religious beliefs.

Premium Stabilization Programs
The Department of Health and Human Services (DHHS) recently released final regulations addressing premium stabilization programs and certain aspects related to the Health Insurance Marketplace.

Final Regulations on New Hire Waiting Periods
The Department of Treasury, Labor, and Health and Human Services (the Departments) recently released final regulations relating to the employment-orientation period. The Affordable Care Act (ACA) limits the new hire waiting period for employer group health plans to not more than 90 days. This provision affected group health plans as of the first day of the plan year on or after January 1, 2014.

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