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Reform News

With the passage of the Patient Care and Affordable Care Act earlier this year, our government has officially enacted reform of hundreds of regulations over employers who provide health care benefits, insurance companies who sponsor these plans and individuals who have previously not had affordable access to either. At Evolution Benefits Consulting, we are committed to guiding our clients through the process of implementing the applicable components of reform regulations.

Our firm provides full client support in all areas of the Affordable Care Act, including guidance in areas such as SBCs, W-2 reporting, Pay or Play analysis.  We monitor pending regulations such as auto enrollment and provide updates to clients as they become available.

Each month, as the Department of Health and Human Services issues more details and guidelines for various aspects of this bill, we will ensure our clients understand the effects on their plans. We communicate the changes as well as timeline for these changes, and assist with enacting the most successful strategy to not only remain compliant with the reform, but to maintain benefit plan affordability and sustainability for both the employer and the employees in the future.


May 2014: Variable Hour Workforce

In our February 2014 Spotlight we provided a brief overview of the final regulations and safe harbor provisions for the variable hour workforce. In this edition, we’ll review each phase and how to go about the calculation for employers with 100 or more employees.

March 2014: ACA Updates

March 2014 continues to bring employers a steady stream of final regulations related to the Affordable Care Act. Recently, final rules were released on employer reporting to the IRS as required under Section 6055 and 6056, as well as confirmation on the reinsurance fees and payment process.

February 2014: The ACA’s Employer Mandate is delayed once again

The one certainty with the Affordable Care Act is that nothing is for certain. Monday the Treasury Department announced the most recent regulations regarding the Affordable Care Act’s employer mandate. This is the rule that requires employers to offer affordable health insurance to full-time employees and full time equivalents (FTE), which is defined as working 30 hours or more. Affordability is defined as employee paying no greater than 9.5 percent of their income, and a plan that pays for the equivalent of 60 percent of healthcare expenses. Businesses that fail to do so will eventually face a fine of up to $2,000 for each employee not offered coverage, though workers are not required to sign up for the benefits.

December 2013: Market View and "Opaque" Transparency

Bill Gates once said that we often over-estimate the change in three years and under-estimate the change in 10 years. While he was referencing technology, the same could now be said related to the employer-based health care market. We expect employee choice and responsibility to increase and employer “administration” to decrease. The question is whether it will occur in 3 years...10 years... We believe it will most likely be 2 to 4 years. The change will happen quickly, accelerated by the public exchange market forces and related laws.

November 2013: FSA Changes & ACA Update

On November 1, the U.S. Treasury announced some major modifications to the “Use It Or Lose It” rule, which required any leftover balance in a Flexible Spending Account (FSA) to be forfeited at the end of the plan year.

September 2013: PPACA Employee Notices

As if the fall season wasn’t already busy enough for employee benefit departments with open enrollment preparation, here is a reminder about the employee notices that are fast approaching. There is the revision to the Notice of Privacy Practices as well as the newly added, Notice of Health Insurance Marketplace.

July 2013: PPACA Employer Checklist

Even though employer reform penalties have been pushed back, there is still a lot to consider in complying with Health Care Reform. Use this checklist as a way to determine what regulations you need to address before the end of the year.

June 2013: Why Defined Contribution Medical Plans will be the Norm (and soon)

There are a number of definitions for the MDC approach. In our context it follows the DC pension plans, where employers provide a fixed allocation and employees select from a menu of investment options, presumably following their risk tolerance and financial needs.

May 2013: The Difference Between Minimum Essential Coverage and Essential Health Benefits

Two phrases that are continually being heard related to the Affordable Care Act are Minimum Essential Coverage and Essential Health Benefits. Some use these phrases interchangeably, but there really is a difference in their meaning and who is required to provide them.

April 2013: What do the Final HIPAA Regulations mean for Group Health Plans?

The Department of Health and Human Services (HHS) recently issued final regulations modifying certain provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and implementing the Health Information Technology for Economic and Clinical Health (HITECH) Act.

March 2013: ACA Employer Next Steps and Audit Checklist

As an employer, there are some components of Affordable Care Act that will require some action/planning within the next 3-6 months.

January 2013: Tips on preventing the flu from taking over your workplace

This year’s flu epidemic may already be affecting your company’s productivity.For obvious reasons, sick workers don’t produce good work.

December 2012: Fees update on the Affordable Care Act

As part of the Patient Protection and Affordable Care Act (ACA), the U.S. Department of Health and Human Services (HHS) recently released proposed regulations regarding the estimated amount of annual contributions that are required to be paid to HHS from employer-sponsored group health plans.

November 2012: Significant Aspects of the Affordable Care Act (ACA)

Many significant aspects of the Affordable Care Act (ACA) such as increasing dependent age, expanded preventative care coverage and grandfathering began in 2011; and other momentous items such as the exchange openings will not occur until 2014.

September 2012: Updates on the Affordable Care Act

On August 31, the regulatory agencies released two separate notices to provide guidance on provisions within the Affordable Care Act (ACA).

April 2012: Generic medications discussed

Generic drug: The term “generic” has several meanings in the context of drugs:

February 2012: HSA comparability testing and Summary of Benefits Requirements

Every year more employers replace their health insurance programs with a High Deductible Health Plan (HDHP) and accompanying Health Savings Account (HSA) contribution. Research continues to demonstrate this as a way to positively impact utilization and control cost increases. Some employers are taking it a step further and crafting wellness campaigns with additional HSA contributions to incent participation in things such as taking health risk assessments, tobacco cessation and other behavior modification programs.