Health Care Reform Legislative Briefs
The VistaNational Health Care Reform (HCR) Legislative Briefs provide important information to help employers prepare and comply with the Affordable Care Act.

 
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Additional Legislative Briefs

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Legislative Brief Archives

Pay or Play Penalty – Common Ownership Aggregation Rules
On Jan. 2, 2013, the IRS released long-awaited proposed regulations on ACA’s employer penalty provisions. The IRS’ proposed regulations address how ACA’s pay or play rules apply to companies that have a common owner or are otherwise related. This Legislative Brief summarizes the aggregation rules for companies under common control, including the relief provided in the proposed regulations.

Defined Contribution Health Plans
Under a defined contribution health plan, an employer gives its employees a fixed contribution to purchase health insurance coverage. Employees use that money to buy or help pay for a health insurance plan they select for themselves. This Legislative Brief summarizes the defined contribution approach to employer-sponsored health coverage and includes information on ACA’s impact on defined contribution health plans.

Model COBRA Election Notice Updated for ACA Changes
On May 8, 2013, the DOL issued an updated model COBRA election notice. The model was updated to provide information on the coverage options that will be available through ACA’s health insurance exchanges and other health care reforms that impact COBRA coverage. This Legislative Brief provides information on the updated model COBRA election notice. Plan sponsors should consider revising their COBRA election notices to include the health care reform updates.

HHS Releases Final Minimum Value Guidance and Calculator
Effective for 2014, to avoid penalties under ACA, a large employer’s health coverage must satisfy minimum value requirements. On Feb. 25, 2013, HHS issued final guidance on three approaches for determining minimum value and a minimum value calculator. This Legislative Brief summarizes the final guidance and provides information on the calculator. It also includes information on the IRS’ proposed rule on minimum value from May 3, 2013.

Small Business Health Options Program (SHOP) and Multi-state Plans
Effective Jan. 1, 2014, the Affordable Care Act (ACA) requires online marketplaces, or Exchanges, to be available in each state for individuals and small businesses to purchase health insurance coverage. This Legislative Brief provides an overview of the Small Business Health Options Program (SHOP) component of the Exchanges. It also describes the Exchange’s multi-state plan program.

Cost-Sharing Limits for Health Plans
Beginning in 2014, ACA requires certain health plans to comply with cost-sharing limits with respect to their coverage of essential health benefits. The cost-sharing limits include both an overall annual limit, or an out-of-pocket maximum, and an annual deductible limit. This Legislative Brief summarizes ACA’s annual deductible limit and out-of-pocket maximum. It has been updated based on the HSA limits for 2014.

Self-insured Plans Under Health Care Reform
Many Affordable Care Act (ACA) reforms apply to all group health plans, regardless of how they are funded. However, some ACA reforms do not apply to self-insured health plans. This Legislative Brief summarizes how ACA’s reforms apply to self-insured health plans.

Proposed Rule Released on Minimum Value and Affordability
On May 3, 2013, the IRS released a proposed rule on the minimum value and affordability rules under the ACA. In this proposed rule, the IRS provides guidance on determining whether health coverage under an employer-sponsored plan is affordable and provides minimum value for purposes of determining the employer “pay or play” penalties.

FAQs on Essential Health Benefits
Beginning in 2014, the health care reform law will require non-grandfathered health insurance plans in the individual and small group markets to cover a comprehensive set of items and services, known as the essential health benefits package. This Legislative Brief contains FAQs issued by HHS regarding its approach for defining essential health benefits.

Pay or Play Penalty – Cafeteria Plan Elections
Beginning in 2014, large employers may be subject to penalties if they do not offer health coverage to full-time employees, or if health coverage does not meet certain standards. On Jan. 2, 2013, the IRS published proposed regulations that provide further guidance on the employer shared responsibility provisions, including a transition rule for health plan coverage elected under a cafeteria plan. This Legislative Brief describes the transition rule.

FAQs on the Individual Mandate
Beginning in 2014, the Affordable Care Act requires most individuals to obtain acceptable health insurance coverage for themselves and their family members or pay a penalty. On Jan. 30, 2013, the IRS issued a set of 24 questions and answers for individual taxpayers relating to the individual mandate. This Legislative Brief contains the FAQs.

Health Insurance Exchanges
The health care reform law calls for the creation of state-based insurance Exchanges. This Legislative Brief provides an overview of state progress toward creating the Exchanges and the role of entities typically involved with the insurance placement process (such as brokers and agents) under the Exchanges. It also discusses the emergence of private health insurance Exchanges.

Pay or Play Penalty – Special Rules for Educational Organizations
On Jan. 2, 2013, the IRS released proposed regulations on ACA’s employer penalty provisions, including methods for identifying full-time employees for penalty purposes. This Legislative Brief summarizes the proposed regulations’ special rules for identifying full-time employees of educational institutions.

FAQs on HRAs and Lifetime or Annual Limits
The ACA generally prohibits health plans and health coverage issuers from imposing lifetime or annual limits on the dollar value of essential health benefits. On Jan. 24, 2013, the DOL issued FAQs that clarify which health reimbursement arrangements (HRAs) must comply with the ACA’s prohibition on annual or lifetime limitations on essential health benefits. The FAQs also provide transition relief, allowing amounts credited to any HRA before Jan. 1, 2014, to be used to reimburse medical expenses.

Questions and Answers on Additional Medicare Tax
The Affordable Care Act (ACA) increases the Medicare hospital insurance tax rate for high-income individuals beginning in 2013. The Additional Medicare Tax applies to individuals’ wages, other compensation and self-employment income over certain thresholds. This Legislative Brief contains questions and answers to help employers understand their responsibilities with respect to the Additional Medicare Tax. It has been updated to include additional questions and answers issued by the IRS.

Preventive Care Coverage Guidelines
The Affordable Care Act (ACA) requires non-grandfathered health plans to cover preventive care services without imposing cost-sharing requirements. This Legislative Brief summarizes ACA’s preventive care coverage guidelines. It also includes information on the preventive care guidelines for women, which are effective for plan years beginning on or after Aug. 1, 2012.

Pay or Play Penalty – Identifying Full-time Employees
On Jan. 2, 2013, the IRS issued proposed regulations on the Affordable Care Act’s (ACA) employer penalty provisions. This Legislative Brief provides an overview of an optional method for identifying full-time employees for purposes of determining and calculating an employer’s potential liability for an ACA penalty.

Automatic Enrollment Requirements
Section 18A of the FLSA requires certain large employers that offer health coverage to automatically enroll new employees (and re-enroll current employees) in one of the employer’s health plans, subject to any permissible waiting period. On Dec. 22, 2010, the DOL, HHS and Treasury issued FAQs on section 18A. Additionally, on Feb. 9, 2012, the DOL issued guidance to answer questions on the automatic enrollment requirements. This Legislative Brief contains the automatic enrollment guidance.

Pay or Play Penalty – Dependent Coverage Requirements
Beginning in 2014, large employers may be subject to penalties if they do not offer health coverage to full-time employees, or if coverage does not meet certain standards. On Jan. 2, 2013, the IRS published proposed regulations that provide guidance on the employer shared responsibility provisions, including the requirement to cover dependents. These proposed rules clarify the definition of “dependent” and provide transition relief for plan years that begin in 2014.

Large Employers Subject to Pay or Play Penalty
On Jan. 2, 2013, the IRS released long-awaited proposed regulations on ACA’s employer penalty provisions. This Legislative Brief summarizes the proposed regulations’ guidance on how to determine if an employer is a large employer that may be subject to a penalty ACA’s pay or play rules.

Coverage for Substantially All Full-Time Employees and Dependents
On Jan. 2, 2013, the IRS released long-awaited proposed regulations on ACA’s employer shared responsibility provisions. The IRS’ proposed regulations address who a large employer must offer coverage to in order to avoid an ACA penalty. This Legislative Brief explains the proposed regulations’ “substantially all” standard for full-time employees and also identifies the dependents who must be offered coverage to avoid an ACA penalty.

Nondiscrimination Rules for Fully-Insured Group Health Plans
Health care reform will require non-grandfathered, fully-insured group health plans to follow nondiscrimination rules related to compensation. This Legislative Brief summarizes these nondiscrimination requirements and their delayed effective date.

FAQs on the Employer Shared Responsibility Provisions
Beginning in 2014, large employers may be subject to penalties if they do not offer health coverage to full-time employees, or if their health coverage does not meet certain standards. On Dec. 28, 2012, the IRS issued FAQs to help employers comply with these requirements. This Legislative Brief contains the IRS’ questions and answers.

Health Care Tax Credit for Small Employers
Health care reform provides a tax credit to small employers that offer health insurance coverage to their employees. This Legislative Brief provides an overview of the health care tax credit for small employers.

Lifetime and Annual Limits
This Legislative Brief describes the interim final regulations regarding prohibitions against lifetime and annual limits on the dollar value of health benefits under the Affordable Care Act (ACA). This mandate is effective for plan years beginning on or after Sept. 23, 2010. It also addresses developments with the annual limit waiver application process.

60-Day Advance Notice of Plan Changes
Health care reform requires 60 days’ advance notice of certain changes in plan terms or coverage. This Legislative Brief explains the 60-day advance notice requirement. It has been updated for the final regulations on the summary of benefits and coverage.

Grandfathered Plans – Permitted and Prohibited Changes
This Legislative Brief summarizes the types of health plan changes that will allow plans to maintain their grandfathered status (permitted changes) and those that will cause plans to lose their grandfathered status (prohibited changes).

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