The SBC will be a summary of the plan or coverage, with a focus on key features such as:

• covered benefits;
• cost-sharing requirements;
• limits on coverage; and
• excluded benefits.

The rules state that consumers should receive the SBC:

• when shopping for coverage;
• when coverage is renewed;
• whenever material changes are made to the plan during the plan year; and
• on demand.

These rules go into effect for plan years beginning on or after September 23, 2012 to give insurers and plans more time for implementation. Paychex Insurance Agency is reviewing the released rules document to determine how it may best support its clients in meeting this requirement.

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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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.

• The goal of SHOP is to allow small businesses (up to 100 employees, as the state may direct) to purchase coverage at rates similar to that of a large group.
• One uniform application for SHOP for employees.
• Large groups (100+ employees) may purchase coverage from insurers within the SHOP beginning in 2017.

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.

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Key Amendments Include:*

• Urgent care claim determinations may take up to 72 hours (the original timeframe under the DOL claims regulation), rather than 24 hours.
• Diagnosis and treatment codes are no longer required in claim denial notices.
• Except for certain minor errors, if a health plan fails to "strictly adhere" to all of the requirements, the claimant is deemed to have exhausted the internal claims and appeals process and can proceed to external review or court.
• The last day of the transition period for all health insurance issuers offering group and individual health insurance coverage is now December 31, 2011.

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.

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*Amended regulations do not apply to grandfathered group health plans.

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.

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.

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.

• Online Tax Credit Estimator
• Credit Breakdown Reference Chart
• Small Business Tax Credit Package
• Small Business Tax Credits FAQ
• CPE-Credited Health Care Reform Seminar
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