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Compliance News

May was a busy month for compliance news, and UBA — specifically, UBA Chief Compliance Officer Linda Rowings — was up to the task of keeping Partners informed.

PPACA Employee Guide

UBA has created an overview of the employee’s responsibility to purchase coverage under PPACA (the individual mandate) and on the basics of the exchanges.  The information in this piece is basic, but should provide a starting place for employers who want to educate their employees on this law.Because PPACA is complicated, and employee eligibility for tax credits through the exchanges is dependent on the employer’s decisions about plan design, a “one size fits all” approach to employee education does not seem workable.  To try to address immediate questions that may arise from the basic guide, we have prepared two supplements to address whether the coverage provided by the employer will satisfy the “minimum essential” requirement and to begin to educate on how the plan and the exchange will interact.  Essentially, if the employer expects to offer affordable, minimum value coverage, employees may enroll in the exchange instead, but will not be eligible for tax credits/premium subsidies.  These employers should use Supplement A.  If the employer expects to offer coverage that does not meet affordability or minimum value, eligibility for tax credits/premium subsidies (and reduced cost sharing) becomes an area of interest.  These employers should use Supplement B.  Employers with employees who may be eligible for subsidies or Medicaid likely should plan to send these individuals to the exchanges for assistance rather than trying to provide extensive assistance themselves, as the rules are quite complicated, and would require the employer to access information about household income that it probably does not want.

We recognize that there are many situations that Supplements A and B do not cover – you should be able to mix and match the information in them to address most situations. HHS refers to the exchanges as the “Health Insurance Marketplace” in the model exchange notices, so we have used that term in the employee piece.

Decision GuidesThe Decision Guides have been updated to include recent changes and clarifications with respect to the maximum eligibility waiting period, minimum value requirements, individual mandate rules and SHOP exchange options.  They have also been updated to include the 2014 maximum out-of-pocket figures, to correct typos in the PCORI dates, and to delete the reference to a maximum deductible in the individual exchange.  These changes affect the versions for small, midsize and large employers.  The executive summary had no changes and therefore has not been updated.

2014 HSA LimitsThe 2014 HSA Limits piece has been updated to clarify that the out-of-pocket maximum required under PPACA does not apply to grandfathered plans.  (It will be possible to retain grandfathered status after January 2014 if the plan continues to meet grandfathering requirements.)

Rules on Wellness Programs Under PPACAUBA also released a PPACA Advisor Alert that addresses how wellness programs must operate under PPACA beginning in 2014. In many respects, the final rules carry forward rules that have been in effect for wellness programs since 2006, and most of the updates that were proposed last November have been adopted.

PPACA Summary

Since the last monthly update, the agencies have issued model notices regarding the exchange/ marketplace. On April 26, the IRS re-released the notice that says that employers that issued fewer than 250 W-2s in the prior calendar year or that participate in multiemployer plans do not need to report health care costs until further notice, so it is highly unlikely this information will be required on 2013 W-2s. 

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