Health Care Reform Highlights

Health Care Reform Highlights

Federal agencies continue to issue new rules and guidance related to a number of requirements under the Affordable Care Act (ACA). The latest updates include the following:

Delay Extended for Small Businesses to Keep Existing Health Coverage
A previously announced transitional policy, which allows some small businesses to renew group coverage that would otherwise be terminated or cancelled, has been extended for an additional two years–to policy years beginning on or before October 1, 2016. Not all states and insurance companies will permit coverage to renew.

Policies subject to the transitional relief will not be considered to be out of compliance with some of the ACA’s key provisions that were originally scheduled to take effect in 2014, including the requirement to cover essential health benefits and limit annual cost sharing under the plan. Insurers that renew coverage under the extended transitional policy are required to provide standard notices to affected businesses for each policy year.

2015 Annual Cost Sharing Limits for Coverage of Essential Health Benefits
The ACA requires yearly updates to the limits on annual out-of-pocket cost sharing for coverage of essential health benefits, applicable to non-grandfathered group health plans (except for policies subject to the transitional relief noted above).

The U.S. Department of Health and Human Services has updated the annual limits based on projections of average per enrollee health insurance premiums for employer-sponsored coverage. As a result:

  • Annual out-of-pocket expenses may not exceed $6,600 for self-only coverage or $13,200 for family coverage in 2015.
  • For small group plans, annual deductibles may not exceed $2,050 for self-only coverage or $4,100 for family coverage in 2015. (Certain small group plans may exceed the annual deductible limit if the plan cannot reasonably reach a given level of coverage, or metal tier, without exceeding the deductible limit.)

Final Rules on Information Reporting Requirements for Employers
Two sets of final regulations provide guidance on, and simplify, the ACA information reporting requirements for employers. The first employer information reports are due in 2016 (for the 2015 reporting year).

One set of rules addresses minimum essential coverage reporting required for certain self-insuring employers. Another set of rules relates to the requirement that large employers (generally those with 50 or more full-time employees, including full-time equivalents) report information to the IRS and to their employees about their compliance with the “pay or play” provisions and the health care coverage they have offered.

Note that an employer with 50 to 99 full-time employees (including full-time equivalents) that wishes to qualify for transition relief from the “pay or play” requirements for 2015 must certify that it meets certain eligibility conditions on the information reporting form.

The latest ACA updates are featured in our Health Care Reform section.