Tag Archives: Insurance Compliance

Poll: Americans Largely Oblivious to Supreme Court Case on Obamacare’s Future

7 in 10 Americans have heard little or nothing about the case

A great deal of Americans will be taken by surprise should the Supreme Court rule against the Affordable Care Act in the coming weeks — a new poll finds seven in ten Americans say they’ve only heard a little or nothing at all about the pending case.

According to a new poll by the Henry J. Kaiser Family Foundation, 44% of Americans haven’t heard anything while 28% have heard only a little about King v. Burwell, a case due to be heard within weeks that could cause millions to lose federal subsidies for health insurance.

Though more people report knowing about the case than did when the Court announced it would take it up, the lack of knowledge isn’t a good sign given the impact the case could have on health insurance for low and middle-income Americans.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

This is How The IRS Handles Marriage and Health Tax Credits

If you’re about to tie the knot, do you know how a change in marital status could affect the credit you got toward health insurance when you were single? You could end up having to repay a big chunk of the money. Here’s the question and an answer that lays out the way the IRS handles the situation.

Last year, I had single coverage through the marketplace from January through May. Then I got married and canceled my policy because I had coverage through my husband’s job for the rest of the year. When I filed my 2014 taxes, we had to repay half of the premium tax credits for the months when I had a marketplace plan. Why? Those first five months I was single and relying on my own income. Why should my husband’s income be counted

The Internal Revenue Service has a special rule to handle situations like yours when people get married during the tax year. Though not a perfect solution, without it, chances are you would have had to repay even more of your tax credit.

First, though, here’s some background. The premium tax credits that people can qualify for if their income is under 400 percent of the federal poverty level (about $46,000 for one person) make coverage purchased on the health insurance marketplace more affordable. Like you, many people opt to receive the credit in advance and have it sent directly to their insurer, which reduces their monthly bill.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Most Doctors Don’t Follow Guidelines for Patients

For all their talk about evidence-based medicine, a lot of doctors don’t follow the clinical guidelines set by leading medical groups.

Consider, for example, the case of cataract surgery. It’s a fairly straightforward medical procedure: Doctors replace an eye’s cloudy lens with a clear, prosthetic one. More than a million people each year in the U.S. have the surgery — most of them older than 65.

“The procedure itself is relatively painless and quick,” says Dr. Catherine Chen, an anesthesiologist and researcher at the University of California, San Francisco. She calls it the “prototypical low-risk surgery.”

And since at least 2002, Chen says, clinical guidelines have stipulated that no preoperative testing is needed before cataract surgery. A large study showed that procedures like chest X-rays, blood tests and EKGs — tests sometimes recommended when older people undergo more complicated surgeries — do not benefit someone who is simply having a cataract removed.

But Chen noticed that a lot of patients are having these preoperative tests done anyway. How many? Digging into the numbers, she discovered that half the ophthalmologists who performed cataract surgery on Medicare patients in 2011 ordered unnecessary tests. That’s the same percentage as in 1995.

“In about 20 years, nothing has really changed in terms of physician performance,” Chen says. She recently published those findings in the New England Journal of Medicine.

Dr. Steven Brown, a professor of family medicine at the University of Arizona, has studied doctors’ reasons for ordering unnecessary tests before a scheduled surgery. A lot of it has to do with perceived safety, he says.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Wellness Programs at Work Clarified

Federal regulators Thursday proposed limits on how employers use financial penalties and rewards to nudge staff to participate in fast-growing workplace wellness programs.

The Equal Employment Opportunity Commission — which enforces laws against discrimination — said Thursday that employers can use financial incentives up to 30 percent of the cost of premiums for single coverage, provided certain other safeguards are met.

Business groups and advocates for people with disabilities are closely watching the issue. Workplace programs that encourage workers to lose weight, quit smoking, get active and better manage stress are spreading throughout American businesses. Employers look for ways to cut costs associated with chronic illnesses, which are often tied to lifestyle.

The 30-percent standard was set in President Barack Obama’s health care overhaul law.

For example, if the total premium paid by the employer and employee for single coverage is $5,000, rewards or penalties for participating in a wellness program under that plan cannot exceed $1,500.

After the health care overhaul passed in 2010, questions arose about potential conflicts with the Americans with Disabilities Act, or ADA, which dates back to 1990 and protects people with chronic conditions against workplace discrimination. That law says wellness programs have to be voluntary.

The employment commission is trying to balance how the two laws can work together.

The proposed regulation says that wellness programs are permitted under the ADA, but employers cannot use them to discriminate based on a worker’s disability. Many wellness programs require employees to complete a health risk assessment questionnaire, and talk the results over with a counselor. Some require employees to take specific actions, such as losing weight or getting blood pressure down to recommended levels.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The IRS Issues Group Insurance Compliance Form Draft

The Internal Revenue Service has issued draft versions of the reporting forms most employers will begin using next year to show that their group health insurance plans comply with the health care reform law.

The long-awaited draft forms, posted late Thursday afternoon to the IRS’ website, are the first practical application of employers’ health care coverage and enrollment reporting obligations under the Patient Protection and Affordable Care Act since the regulations were finalized in March.

The forms are the primary mechanism through which the government intends to enforce the health care reform law’s minimum essential coverage and shared responsibility requirements for employers.

Beginning in 2015, employers with at least 100 full-time employees will be required to certify that benefits-eligible employees and their dependents have been offered minimum essential coverage and that their employees’ contributions to their premiums comply with cost-sharing limits established under the reform law. Smaller employers with 50-99 full-time employees are required to begin reporting in 2016.

Additionally, self-insured employers will be required to submit documentation to ensure compliance with minimum essential coverage requirements under the reform law’s individual coverage mandate.

“In accordance with the IRS’ normal process, these draft forms are being provided to help stakeholders, including employers, tax professionals and software providers, prepare for these new reporting provisions and to invite comments from them,” the IRS said in a statement released Thursday.

The IRS said it expects to publish draft instructions for completing the reporting forms by late August and that both the forms and the instructions would be finalized later this year.

Last year, the Obama administration announced it would postpone implementation of employers’ minimum essential coverage and shared responsibility obligations under the reform law for one year, largely due to widespread complaints about the complexity of the reporting requirements.

Though several months have passed since the administration issued a simplified set of information reporting rules, many employers have delayed preparations for meeting the requirements until the forms and instructions are available for review, said Richard Stover, a principal with Buck Consultants at Xerox in Secaucus, New Jersey.

“A lot of employers really haven’t been doing anything about reporting requirements, even with the final regulations in place, because they were waiting for these forms,” Mr. Stover said. “This is something they’ve been anxious to see.”

Here’s the sample draft.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Insurers to Revamp Law to Reduce Catastrophic Plan Premiums

Insurers want to change President Barack Obama’s health care law to provide financial assistance for people buying bare-bones coverage. That would entice the healthy and the young, the industry says, holding down premiums.

So-called catastrophic plans are currently not eligible for the law’s subsidies, and only 2 percent of the 8 million consumers who signed up this year picked one. Subsidies bring down the cost of monthly premiums.

The proposed change is part of a package of recommendations that America’s Health Insurance Plans, the main industry trade group released Wednesday. Others address how to smooth transitions for consumers who switch insurance companies, as well as making it easier for patients to find out which hospitals and doctors are in particular plans and whether their medications are covered.

“What is crucial for public policy leaders is to balance access and affordability,” said Karen Ignagni, head of the trade group. “Unless people feel that coverage is affordable, they won’t participate in the system.”

Adults ages 18-34, the health care law’s most coveted demographic, are under-represented among those enrolled for subsidized private insurance this year. Insurers are currently filing their proposed premiums for 2015, and increases of 10 percent or more are anticipated. Nonetheless, the new state insurance exchanges are poised to grow, with more carriers entering the market to compete for business.

Catastrophic plans offer low monthly premiums but require consumers to foot a hefty share of their annual medical costs. They are designed to protect healthier people from financial ruin due to an accident or an unexpected diagnosis of serious illness, although they also cover basic preventive care at no cost to the consumer.

Catastrophic plans currently available through the new insurance exchanges are only open to people under 30, as well those who have received a hardship exemption from the health law’s individual requirement to carry a policy.

To read more, click here.

Jeffrey R. Ungvary

President

Jeffrey R. Ungvary

IRS Issues Penalties for Pre-Tax Money to Buy Individual Insurance

The IRS has issued an update on employer penalties, specifically citing employers offering pre-tax monies to their workers to purchase individual insurance.

The IRS calls this an employer payment plan, and is viewed as a group health plan that does not meet the Affordable Care Act (ACA) rules.

For example, employer payment plans do not meet parts of the ACA that give workers certain preventive care benefits at no cost share. Because employer payment plans do not meet all ACA rules, employers may be taxed $100 per day for each employee this applies to. (That adds up to $36,500 per year, per worker.)

This is an excellent incentive for employers to continue to offer group employee benefits,  rather than pay their employees to get coverage.

To read more, click here.

Jeffrey R. Ungvary

President

Jeffrey R. Ungvary

 

Victory for Health FSAs, HRAs, and HSAs

In early April, President Obama signed the Protecting Access to Medicare Act, which repeals a troubling provision of the Affordable Care Act (ACA) for small group market health plans. This law has an indirect, but positive effect on account-based plans for small employers.

To learn more regarding the repeal, click here.

Jeffrey R. Ungvary

President

Jeffrey R. Ungvary

Obamacare Deadline and The SHOP

Leading news stories this week focus on Obamacare enrollment reaching their 6 million mark and extending enrollment for those who began the process. However some states like New York have set a hard deadline for March 31st. To read more, click here.

Also reaching headlines is the Small Business Health Options Program (SHOP). Business with 50 or fewer employees may purchase private health insurance for their employees, and employers with fewer than 25 employee and lower-wage workforces earn a tax credit for doing so. Read more about the shop here.

Jeffrey R. Ungvary

President

Jeffrey R. Ungvary