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Federal / Affordable Care Act

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1. The Affordable Care Act

Remember that each provision of the ACA may apply to different market segments i.e. individual (consumer) v small group v large group (ALEs).

Due to the volume of information, it's best if you search for your topic by doing a word search.

Timeline chart
http://www.healthcare.gov/law/timeline/ 

http://healthreform.kff.org/timeline.aspx
2. -Grandfather Plan Status  
 
-Nursing Mothers mandate  

  
3. Small Business Tax Credit
4.
-Annual/ Lifetime dollar limit prohibition
-Dependent to 26 coverage
-Emergency services covered in network
-External Review Standards - Appeals
-Non-discrimination or prohibition in favor of Highly Compensated Individuals
     This new prohibition applies to fully insured plans and is on hold
-Pre-existing condition limitation prohibition for persons under age 19
-Premium Rate Review
-Preventive Care Services without cost sharing includes Women's Contraceptive -Primary Care Physician (PCP) selection
-Rescission prohibition
-Wellness

5. What are the requirements regarding Medical Loss Ratios (MLR) expenditure and refunding ?

How is this affected by the PACE act whereby some states elected to define small group as 1-100 in 2016 ?
6. Is there a requirement for employers to report the total premium cost of health benefits on the W-2?
7. Is there a change to the tax penalty for using HSA funds for other than qualified medical expenses ?
8. Is there a limit to employee funding of an FSA ?
9. Is there a change to the definition of an eligible medical expense with regards to OTC (over the counter) drugs ?
10. The CLASS Act (long term care funding) has been repealed under the January 1, 2013 Fiscal Cliff deal.
11. What are the Summary of Benefits and Coverage and Uniform Glossary (SBC) requirements ?

12. Fees and Taxes
13. What is the change to the medical expense tax deduction limitation ?
14. What is the latest regarding Exchanges (now known as the Health Insurance Marketplace) ?

http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/?currentTimeframe=0  

STATE based exchange info may be found here
https://www.cms.gov/CCIIO/Resources/Data-Resources/sbm-puf.html 

As of January 2017
12 State-based exchanges
 
5 State-based exchanges using the federal platform
 
28 Federally facilitated marketplaces
 
6 State Partnership exchanges
 

 
15. What changes have occurred since 2014 and will occur in the future with regards to the Rating Methodology?
16. What is the size definition and determination of "small group plan" ?
17. What are the available premium tax credits a/k/a subsidy/ subsidies ?  
APTC (Advanceable Premium Tax Credits)

Who is eligible for Catastrophic coverage?

The Basics and Who is Eligible IRS FAQ here
https://www.irs.gov/affordable-care-act/individuals-and-families/questions-and-answers-on-the-premium-tax-credit

See the IRS Publication 974 here for helpful information:
https://www.irs.gov/pub/irs-pdf/p974.pdf

Reporting life changes
https://www.healthcare.gov/how-do-i-report-life-changes-to-the-marketplace/

Kaiser FAQ http://khn.org/news/what-are-the-penalties-for-not-getting-insurance/ 

The Supreme Court ruled on June 25, 2015 that the Affordable Care Act’s subsidies can go to residents of any state. In a 6-3 ruling, the justices said that the Affordable Care Act as written does allow subsidies to be provided in the 34 states that declined to set up their own insurance exchange.

See our QuickFlash news Published: Thursday, June 25, 2015

 

18. When did all pre-existing condition limitation exclusions end ?
19. What are Essential Health Benefits ?

Who is subject to them?

Maximum Out of Pocket rules.
20. Coverage for persons eligible for Clinical Trials.
21. What is the Medicaid expansion ?
22. What is the maximum probationary or waiting period that is permitted?

The 90 day maximum rule
23. Are employers mandated to provide coverage ?

Due to the volume of information within this topic, it's best if you search for your topic by doing a word search.

The  following categories related to the Employer Shared Responsibility (ESR) / Play or Pay will be covered in this FAQ section.

24. Is there an Individual Shared Responsibility "mandate" ?

IRS FAQ
http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision 

Getting coverage outside of open enrollment
https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/

The Tax Policy Center calculator lets individuals estimate the potential ACA penalty for individuals and families who don’t have health insurance coverage.
http://taxpolicycenter.org/taxfacts/acacalculator.cfm

Link to Tax Preparer’s Guide to ACA 
http://www.healthreformbeyondthebasics.org/tax-preparer-guide-to-the-affordable-care-act/
 
25. The "Free-Choice" Voucher provision was eliminated.
26. Are Wellness programs mentioned in the law ?
27. What are the criteria for establishment of SIMPLE Cafeteria Plans for Small Businesses ?
28. How are Self-Funded plans impacted ?
29. What is the meaning of "culturally and linguistically appropriate manner" ?
30. What are the Information Reporting Rules for Employers, Plans and Carriers under PPACAs IRC Codes 6055 and 6056?

Also known as 1094 / 1095 reporting.
31. Where can I find more information ?

Related Information

Please refer to the following documents for additional information:

There is no related information available.



1. The Affordable Care Act

Remember that each provision of the ACA may apply to different market segments i.e. individual (consumer) v small group v large group (ALEs).

Due to the volume of information, it's best if you search for your topic by doing a word search.

Timeline chart http://www.healthcare.gov/law/timeline/ 

http://healthreform.kff.org/timeline.aspx
You are not authorized to view this answer. To gain access to this content, Please click here.
2. -Grandfather Plan Status  
 
-Nursing Mothers mandate  

  
You are not authorized to view this answer. To gain access to this content, Please click here.
3. Small Business Tax Credit
You are not authorized to view this answer. To gain access to this content, Please click here.
4.
-Annual/ Lifetime dollar limit prohibition
-Dependent to 26 coverage
-Emergency services covered in network
-External Review Standards - Appeals
-Non-discrimination or prohibition in favor of Highly Compensated Individuals
     This new prohibition applies to fully insured plans and is on hold
-Pre-existing condition limitation prohibition for persons under age 19
-Premium Rate Review
-Preventive Care Services without cost sharing includes Women's Contraceptive -Primary Care Physician (PCP) selection
-Rescission prohibition
-Wellness

You are not authorized to view this answer. To gain access to this content, Please click here.
5. What are the requirements regarding Medical Loss Ratios (MLR) expenditure and refunding ?

How is this affected by the PACE act whereby some states elected to define small group as 1-100 in 2016 ?
You are not authorized to view this answer. To gain access to this content, Please click here.
6. Is there a requirement for employers to report the total premium cost of health benefits on the W-2?
You are not authorized to view this answer. To gain access to this content, Please click here.
7. Is there a change to the tax penalty for using HSA funds for other than qualified medical expenses ?
You are not authorized to view this answer. To gain access to this content, Please click here.
8. Is there a limit to employee funding of an FSA ?
You are not authorized to view this answer. To gain access to this content, Please click here.
9. Is there a change to the definition of an eligible medical expense with regards to OTC (over the counter) drugs ?
You are not authorized to view this answer. To gain access to this content, Please click here.
10. The CLASS Act (long term care funding) has been repealed under the January 1, 2013 Fiscal Cliff deal.
You are not authorized to view this answer. To gain access to this content, Please click here.
11. What are the Summary of Benefits and Coverage and Uniform Glossary (SBC) requirements ?

You are not authorized to view this answer. To gain access to this content, Please click here.
12. Fees and Taxes
You are not authorized to view this answer. To gain access to this content, Please click here.
13. What is the change to the medical expense tax deduction limitation ?
You are not authorized to view this answer. To gain access to this content, Please click here.
14. What is the latest regarding Exchanges (now known as the Health Insurance Marketplace) ?

http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/?currentTimeframe=0  

STATE based exchange info may be found here
https://www.cms.gov/CCIIO/Resources/Data-Resources/sbm-puf.html 

As of January 2017
12 State-based exchanges
 
5 State-based exchanges using the federal platform
 
28 Federally facilitated marketplaces
 
6 State Partnership exchanges
 

 
You are not authorized to view this answer. To gain access to this content, Please click here.
15. What changes have occurred since 2014 and will occur in the future with regards to the Rating Methodology?
You are not authorized to view this answer. To gain access to this content, Please click here.
16. What is the size definition and determination of "small group plan" ?
You are not authorized to view this answer. To gain access to this content, Please click here.
17. What are the available premium tax credits a/k/a subsidy/ subsidies ?  
APTC (Advanceable Premium Tax Credits)

Who is eligible for Catastrophic coverage?

The Basics and Who is Eligible IRS FAQ here
https://www.irs.gov/affordable-care-act/individuals-and-families/questions-and-answers-on-the-premium-tax-credit

See the IRS Publication 974 here for helpful information:
https://www.irs.gov/pub/irs-pdf/p974.pdf

Reporting life changes
https://www.healthcare.gov/how-do-i-report-life-changes-to-the-marketplace/

Kaiser FAQ http://khn.org/news/what-are-the-penalties-for-not-getting-insurance/ 

The Supreme Court ruled on June 25, 2015 that the Affordable Care Act’s subsidies can go to residents of any state. In a 6-3 ruling, the justices said that the Affordable Care Act as written does allow subsidies to be provided in the 34 states that declined to set up their own insurance exchange.

See our QuickFlash news Published: Thursday, June 25, 2015

 

You are not authorized to view this answer. To gain access to this content, Please click here.
18. When did all pre-existing condition limitation exclusions end ?
You are not authorized to view this answer. To gain access to this content, Please click here.
19. What are Essential Health Benefits ?

Who is subject to them?

Maximum Out of Pocket rules.
You are not authorized to view this answer. To gain access to this content, Please click here.
20. Coverage for persons eligible for Clinical Trials.
You are not authorized to view this answer. To gain access to this content, Please click here.
21. What is the Medicaid expansion ?
You are not authorized to view this answer. To gain access to this content, Please click here.
22. What is the maximum probationary or waiting period that is permitted?

The 90 day maximum rule
You are not authorized to view this answer. To gain access to this content, Please click here.
23. Are employers mandated to provide coverage ?

Due to the volume of information within this topic, it's best if you search for your topic by doing a word search.

The  following categories related to the Employer Shared Responsibility (ESR) / Play or Pay will be covered in this FAQ section.

You are not authorized to view this answer. To gain access to this content, Please click here.
24. Is there an Individual Shared Responsibility "mandate" ?

IRS FAQ
http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision 

Getting coverage outside of open enrollment
https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-enrollment/

The Tax Policy Center calculator lets individuals estimate the potential ACA penalty for individuals and families who don’t have health insurance coverage.
http://taxpolicycenter.org/taxfacts/acacalculator.cfm

Link to Tax Preparer’s Guide to ACA 
http://www.healthreformbeyondthebasics.org/tax-preparer-guide-to-the-affordable-care-act/
 
You are not authorized to view this answer. To gain access to this content, Please click here.
25. The "Free-Choice" Voucher provision was eliminated.
You are not authorized to view this answer. To gain access to this content, Please click here.
26. Are Wellness programs mentioned in the law ?
You are not authorized to view this answer. To gain access to this content, Please click here.
27. What are the criteria for establishment of SIMPLE Cafeteria Plans for Small Businesses ?
You are not authorized to view this answer. To gain access to this content, Please click here.
28. How are Self-Funded plans impacted ?
You are not authorized to view this answer. To gain access to this content, Please click here.
29. What is the meaning of "culturally and linguistically appropriate manner" ?
You are not authorized to view this answer. To gain access to this content, Please click here.
30. What are the Information Reporting Rules for Employers, Plans and Carriers under PPACAs IRC Codes 6055 and 6056?

Also known as 1094 / 1095 reporting.
You are not authorized to view this answer. To gain access to this content, Please click here.
31. Where can I find more information ?
You are not authorized to view this answer. To gain access to this content, Please click here.