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Delay of Summary of Benefits and Coverage Requirement
On November 17, 2011, the Departments of the Treasury, Health and Human Services, and Labor indefinitely delayed the summary of benefits and coverage (SBC) requirement that would have taken effect March 2012. The Departments released updated Frequently Asked Questions in response to the comments they have received regarding the proposed SBC regulations.
As part of this delay, group health plans and insurance carriers are not required to comply with the SBC requirement until final regulations have been issued. Although the timeframe for this requirement to go into effect has not been issued, the departments have stated that the date will give group health plans, insurance carriers, and plan administrators ample time to comply.
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Proposed Rule for Health Insurance Exchanges
On July 11, 2011 the Department of Health and Human Services (HHS) released a proposed rule related to the establishment of Health Insurance Exchanges (HIX) under the Patient Protection and Affordable Care Act (PPACA).
Small Business Health Options Program (SHOP)
As part of the proposed rule, guidelines were set for employers to participate in SHOP—the small group provision of HIX.
For specifics on the proposed rule and how it affects states, carriers, agents and brokers, and employers, please visit the Department of Health and Human Services.
HHS is accepting public comments on this proposed rule within 75 days of its release. All Exchange regulations are expected to be finalized by mid-2012.
Claims Appeals and External Review Process Amended
Effective July 22, 2011, the U.S. Departments of Labor (DOL), Health and Human Services (HHS), and the U.S. Department of the Treasury have amended group health insurance plan regulations regarding claims appeals and the external review process.
Key Amendments Include:*
Covered employees must still appeal insurance claims through an internal review process. If a claim is denied, a claimant may be eligible for an independent external federal or state review.
*Amended regulations do not apply to grandfathered group health plans.
Budget Deal Repeals Health Care Voucher Provision
President Obama signed into law a bill repealing a Health Care Reform provision that required employers who offer health coverage and pay a portion of the cost to give health insurance vouchers to low-earning employees.
Under the provision, which would have taken effect in 2014, employees who met certain conditions (based on household income, previous participation in an employer's plan, and required premium contributions) would have been eligible for vouchers, allowing them to use employer funds to help pay for the cost of coverage received through health insurance exchanges.
Bill Repeals 1099 Information Reporting Requirements
On April 14, 2011, President Obama signed into law the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011.
Under this Act, businesses are no longer required to issue a Form 1099-MISC to corporations and non-corporate entities concerning the purchase of goods and services for any person or company to whom they paid more than $600 in a tax year. It also repeals a requirement for individuals to report rental income on Form 1099-MISC.
In order to offset lost revenue, the law requires individuals who receive excessive tax subsidies for state health care to pay back a larger amount than formerly required under the Patient Protection and Affordable Care Act of Heath Care Reform.
IRS Delays Forms W-2 Health Care Cost Reporting Requirement for Smaller Employers
On March 29, 2011, the IRS issued interim guidance regarding the W-2 provision of the Affordable Care Act.
According to IRS Notice 2011-28, employers that issue fewer than 250 Forms W-2 in 2011 will not be required to report the cost of employer sponsored health coverage on their tax year 2012 Forms W-2.
Employers filing 250 or more Forms W-2 in 2011 will still be required to include the cost of employer-sponsored health coverage on the forms for tax year 2012.
Help Your Clients File for a Health Care Reform Tax Credit
Did you know that under the small business tax credit provision of Health Care Reform, tax credits are available for eligible employers who offer health insurance? Rely on Paychex to help you get the information your clients need to file for the credit.
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Health Care Reform Seminar Series
