One of the Affordable Care Act’s (ACA) 18 new Taxes, Elimination of Deductions, and New Fees is something called the Patient -Centered Outcomes Research Institute fee (or PCORI for short). The fee is applicable to virtually any health insurance plan (both fully insured and self-funded), specifically the following:
– Fully insured medical plans (individual and group)
– Self funded group health plans (including some HRA and FSA plans)
– Retiree only medical plans
– COBRA health insurance coverage
– Limited or Mini-Medical plans
– Federal/State/Local governmental health plans offered by an employer
In my travels and presentations to various employer organizations around the country, I’m finding a great deal of misunderstanding concerning one of the more pressing aspects of the Affordable Care Act (or Obamacare) – the so called “employer shared responsibility” provision. Also referred to as the “employer mandate” and the “pay or play provision”, this aspect of the ACA poses two distinct types of penalty exposure to affected employers (generally those that employ at least 50 full time and full time equivalent employees). It’s extremely important to clarify that these penalties represent EXPOSURE, first and foremost; and only become actual payable penalties if specific action is taken by EMPLOYEE(s).
One of the most challenging aspects of Affordable Care Act (ACA) compliance is all the new forms, notices, and summaries required to be drafted, edited, approved, and ultimately distributed. The Department of Labor (DOL) recently issued guidance intended to assist employers in providing ACA related information to employees. This blog entry is intended to provide readers with a “heads up” on some new and revised notice/summary changes, and deadlines, resulting from the DOL’s guidance.
Employers were initially required by the ACA to provide notices to all current and newly hired employees regarding the existence of, and access to the new health insurance exchanges (now referred to…
The “trinity” of ACA enforcement (i.e., Departments of Labor, Treasury, and Health and Human Services) issued final regulations relative to wellness programs and rewards, on May 29, 2013. There were no surprises to what we already knew from the law itself. But reviewing the briefing reminded me that there are two (2) profoundly different types of wellness programs:
1. “Participatory”; and 2. “Health-Contingent”. Program rewards for the later are regulated/limited by the ACA, beginning in 2014, to no more than 30% (an increase from the present amount of 20%). However, there are NO LIMITS placed/regulated for the former type – Participatory – wellness programs. It is also important to note that the ACA allows a penalty of up to 50% for programs related to tobacco use.