new developments in health care reform

Copyright 2015- Not to be reproduced without express permission of Benefit Express Services, LLC

New Developments in

Health Care Reform

By

Larry Grudzien

Attorney at Law

Impact of Health Reform on HRAs and Cafeteria Plans


• Impact of Health Care Reform on HRAs and Cafeteria Plans

• Transitional Rules for application of the Employer Mandate for 2015

• New Waiting Period Rules

• Reporting Requirements for Employers for 2015

• Rules for allowing employees to drop employer coverage and enroll on the Marketplace

• Contraceptive coverage after Hobby Lobby

• Other Developments

Agenda

Impact of Health Reform on

HRAs and Cafeteria Plans



• Cannot reimburse employees for individual medical

premiums.

• Must be integrated with group medical plan.

• Can be free standing for other coverages (dental & vision).

• Can be free standing for retiree benefits

HRAs



• For Health FSAs to avoid the requirements of Health Care

Reform, they must meet the requirements of an “excepted

benefit.”

• Free standing health FSAs are still possible if reimburse

excepted benefits.

• What requirements apply if a Health FSA is not an excepted

benefit?

• Limit for 2015 is $2,550.

Health FSAs



• A health FSA is considered an “excepted benefit” if it satisfies

two conditions:

Maximum Benefit Condition: The maximum benefit payable under the

health FSA to any participant in the class for a year cannot exceed two

times the employee's salary reduction election under the health FSA for

the year (or, if greater, the amount of the employee's salary reduction

election for the health FSA for the year, plus $500), and

Availability Condition: Other nonexcepted group health plan coverage

(e.g., major medical coverage) must be made available for the year to

the class of participants by reason of their employment.

Health FSAs



• For medical premiums to be reimbursed, it must be made

after-tax and not conditioned on purchasing coverage

• Possible to reimburse premiums of other coverage:

Dental

Vision

Disability

Life insurance

Voluntary benefits

When is it possible reimburse individual premiums under a Cafeteria Plan?



• On May 13, 2014, the IRS issued Q&A guidance restating the conclusion in Notice 2013-54, that an employer is considered to establish a type of group health plan-called an "employer payment plan"-if it reimburses employees' premiums for individual health insurance policies.

• Q/A-1 provides that the employer's exposure to excise taxes of $36,500 per year (i.e., $100 per day) for each employee affected by the failures. This excise tax liability requires self-reporting on IRS Form 8928. Adverse consequences are also possible under ERISA and the PHSA.

• Q/A-2 indicates that the DOL issued substantially identical guidance in Technical Release 2013-03, and HHS is expected to announce soon that it concurs.

Recent Guidance



• On February 18, 2015, the IRS released Notice 2015-17

which provides transition relief from the assessment of excise

tax under Code Section 4980D for failure to satisfy market

reforms in certain circumstances.

• The transition relief applies to employer healthcare

arrangements that constitute:

Employer payment plans, as described in Notice 2013-54, if the plan is

sponsored by an employer that is not an Applicable Large Employer

(ALE) under Code § 4980H(c)(2) and §§54.4980H-1(a)(4) and -2;

S corporation healthcare arrangements for 2-percent shareholder-

employees;

Medicare premium reimbursement arrangements; and

TRICARE-related health reimbursement arrangements (HRAs).

Recent Guidance



• The IRS will not impose excise taxes otherwise assessable

under Code § 4980H for employer payment plans maintained

in 2014 or the first six months of 2015 (i.e., through June 30,

2015) for employers that are not “applicable large employers”

(ALEs) for those periods.

• Employers eligible for the relief are also excused from the

requirement to self-report these violations on Form 8928.

• The Notice relief does not apply to stand-alone HRAs or other

arrangements to reimburse any expenses other than

insurance premiums.

Recent Guidance



• The Notice also addresses “2% shareholder-employee

healthcare arrangements,” under which a Subchapter S

corporation pays for or reimburses premiums for individual

health insurance coverage for a “2% shareholder” where the

payment or reimbursement is included in income and the

premiums are deductible by the 2% shareholder-employee

under Code § 162(l).

• Pending the issuance of additional guidance on these

arrangements, the Notice provides that an S corporation will

not be subject to Code § 4980D or required to file Form 8928

solely as a result of having a 2% shareholder-employee

health care arrangement.

Recent Guidance



• The Notice permits an employer’s reimbursement of Medicare Part B or Part D premiums to be integrated with another group health plan offered by the employer, but only if:—

The employer offers a group health plan (other than the premium

reimbursement arrangement) to the employee that does not consist solely of excepted benefits and offers coverage providing minimum value;

The employee participating in the premium reimbursement is actually enrolled in Medicare Parts A and B;

Premium reimbursement is available only to employees who are enrolled in Medicare Part A and Part B or Part D; and

Reimbursement is limited to Medicare Part B or Part D premiums and premiums for excepted benefits, including Medigap premiums.

Recent Guidance



• The Notice confirms that an employer may increase an

employee’s taxable compensation, not conditioned on the

purchase of health coverage, without creating an employer

payment plan (or any group health plan at all).

• The Notice reiterates the IRS’s position that an employer’s

payment or reimbursement of employees’ individual health

insurance premiums is a group health plan subject to the

market reforms even if the payments or reimbursements are

made on an after-tax basis.

Recent Guidance



• Allow up to $500 carryover to 2014 and later

• Carryover can allowed to be used for all or the next plan year

• Many unanswered questions from guidance

• Cafeteria plan must be amended to allow

Health FSAs



• Notice 2014‐55 addresses cafeteria plan elections in two specific situations related to the availability of coverage through a Health Insurance Exchange (or Marketplace).

• An employee may want to revoke an election under his or her employer’s plan in order to purchase coverage through an Exchange if: The employee’s hours of service are reduced so that the employee is expected to

average less than 30 hours of service per week, but the reduction does not affect eligibility for coverage under the employer’s group health plan; or

The employee would like to cease coverage under the employer’s group health plan and purchase coverage through an Exchange, without having a period of either duplicate coverage or no coverage.

• In each of these situations, Notice 2014‐55 permits a cafeteria plan to allow an employee to prospectively revoke his or her election for coverage under the employer’s group health plan during a period of coverage.

Participation in Cafeteria Plan

Transitional Rules for the

Employer Mandate for 2015



• For 2015, employer mandate will apply to those employers

with 100 or more full-time employees if transitional rules are

met.

• For the application of the $2,000 penalty in 2015 -30

employee reduction is increased to 80.

• To avoid the $2,000 penalty in 2015, employer must offer

coverage to 70% of all full time employee, instead of 95%.

• Large employer determination for 2015, can be made over

either calendar year 2014 or any consecutive 6 month period

in 2014.

Large Employer for Employer Mandate Purposes



• Large Employers will not be subject to the employer mandate

penalties until the first day of the plan year in 2015 for

employees who are either enrolled or were eligible to enroll in

the plan as of February 9, 2014.

• If these employees are offered affordable, minimum value

coverage no later than the first day of the 2015 plan year, the

large employer will not be liable for a penalty with respect to

these employees for the months in 2015 before the plan year

begins.

Large Employers with Noncalendar Plans



• Transition relief for employers with a significant percentage of

employees eligible for or covered under a non‐calendar year

plan, if the large employer:

Had at least one quarter of its employees covered under those

non‐calendar year plans as of any date in the 12 months ending on

February 9, 2014; OR

Offered coverage under those plans to one third or more of its

employees during the open enrollment period that ended most recently

before February 9, 2014.




• Transition relief is extended to employers that have a

significant percentage of full‐time employees eligible for or

covered under a non‐calendar year plan, if the employer:

ƒ Had at least one third of its full‐time employees covered under those

non‐calendar year plans as of any date in the 12 months ending on

February 9, 2014; OR

Offered coverage under those plans to one half or more of its full‐time

employees during the open enrollment period that ended most recently

before February 9, 2014.




• If either of these transition policies apply, the employer will not

be liable for a penalty for months in 2015 before the 2015 plan

year begins with respect to employees who are offered

affordable, minimum value coverage no later than the first day

of the 2015 plan year and who would not have been eligible

for coverage under any calendar year group health plan

maintained by the employer as of February 9, 2014.




• Employers with 50 to 99 full-time employees (including full-time equivalents) will not be subject to penalties until their first plan year on or after January 1, 2016 if all of the following conditions are met:

Employer does not modify its plan year after February 9, 2014 to begin on a later

calendar date;

Employer must not reduce workforce nor hours of service during 2014 to avoid compliance;

Employer must not eliminate or materially reduce health coverage offered on February 9, 2014 through the last day of the 2015 plan year:

• The employer contribution toward employee-only coverage must continue at either the same percentage of the total cost of coverage, or at least 95% of the dollar amount contributed on February 9, 2014.

• If benefits are changed, the coverage provides minimum value after the change and

• Employer does not amend its plan to reduce eligibility of employees or their dependents

• The final regulations require employers to certify to the IRS their eligibility for this transition relief.

Employers with 50-99 employees



• Employers may adopt a transition measurement period that is

shorter than 12 consecutive months but that is no less than

six consecutive months and that begins no later than July 1,

2014, and ends no earlier than 90 days before the first day of

the plan year beginning on or after January 1, 2015.

• May use with a stability of up to 12 months.

• May use 12 month measurement period in 2015 for 2016.

Measurement Period

New Waiting Period



• Period cannot exceed 90 calendar days.

• Applies for plan years beginning in 2014.

• Employer can impose up to a 30 day. orientation period

before the waiting period

• Employer may be subject to an assessable payment if it fails

to offer affordable minimum value coverage to certain newly-

hired full-time employees by the first day of the fourth full

calendar month of employment.

Rules



• For example, if an employee is hired as a full-time employee

on January 6, a plan may offer coverage May 1 and comply

with both provisions.

• However, if the employer is an applicable large employer and

starts coverage May 6, which is one month plus 90 days after

date of hire, the employer may be subject to an assessable

payment under Code § 4980H.

Example

Reporting Requirements for

Employers



• Beginning in 2016 (for information on 2015), insurers and self-funded plans will be required to report information about health coverage provided during the prior year to all enrollees, including Taxpayer Identification Numbers of all covered individuals and the specific dates that such individuals had such health coverage, as required by Code § 6055.

• In addition, employers with 50 or more full-time equivalent employees will be required to report information about health coverage offered during the prior year to full-time employees, including information about the lowest cost option offered and whether the minimum value requirements were satisfied, as required by Code § 6056.

• In February 2015, the IRS published final forms and instructions for 2014 .

• The information will be reported on new IRS Forms 1094 and 1095, and not on Form W-2, as many had hoped.

Overview



• Good Faith Standard for 2015 Penalty Relief.

Both the Code §§ 6055 & 6056 final rules provide for no reporting

penalties for any optional 2014 reporting, and a good faith effort

standard for imposing 2015 reporting penalties for incorrect or

incomplete filings.

Transition relief is available for 2015



• An applicable large employer member who employs an average of 50 or more full-time employees or full-time employee equivalents in the prior calendar year must file the required Code § 6056 form (and furnish a copy to each full-time employee).

• In other words, if your company is subject to the employer mandate rules, it must file the required form (and furnish a copy to each full-time employee).

• In addition, all employers who sponsor self-funded group health plans, insurers, government agencies and others that provide minimum essential coverage (reporting entities) must file the required Code § 6055 form (and furnish a copy to each “responsible individual,” defined as a primary insured, employee, former employee, uniformed services sponsor, parent, or other related person named on an application who enrolls one or more individuals, including him or herself, in minimum essential coverage).

Employers Subject to the Reporting Requirement



• To report for employer responsibility purposes (Code § 6056),

a large employer may hire a third party agent (e.g., plan

administrator) to file on its behalf, but the large employer

member remains liable for the reporting.

• Special rules apply for governmental units and multiemployer

plans.

Employers Subject to the Reporting Requirement



• Form 1095–C (or a substitute form) will be used by self-insured employers to meet both the employer responsibility and the minimum essential coverage reporting requirements.

• An employer that provides insured coverage will also report on Form 1095–C, but will complete only the employer section.

• Employers who are not subject to the employer mandate requirements, health insurance issuers, self-insured, multiemployer plans, and providers of government-sponsored coverage, will report on Form 1095–B (or a substitute form).

• In addition, filers will be required to submit a single Form 1094-B and a single Form 1094-C as a “transmittal form” to the IRS with the Forms 1095-B or 1095-C, respectively.

Forms Used for Filing



• A link to the forms is provided below:

Form 1094-B,Transmittal of Health Coverage Information Return:

http://www.irs.gov/pub/irs-pdf/f1094b.pdf

Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Return: http://www.irs.gov/pub/irs-pdf/f1094c.pdf

Form 1095-A, Health Insurance Marketplace Statement: http://www.irs.gov/pub/irs-pdf/f1095a.pdf

Form 1095-B, Health Coverage: http://www.irs.gov/pub/irs-pdf/f1095b.pdf

Form 1095-C, Employer Provided Health Insurance Offer and Coverage: http://www.irs.gov/pub/irs-pdf/f1095c.pdf

Forms Used for Filing



• The forms are filed with the IRS, in either paper or electronic format (but electronic format is required if at least 250 such returns are filed).

• Statements are also required to be provided to the full-time employee or responsible individual.

• In order to deliver the form to the full-time employee or responsible individual electronically, actual consent from the full-time employee or responsible individual to receive the form electronically is required (similar to the W-2 process).

• If the form is mailed, sending it to the full-time employee or responsible individual’s last known address, via first class mail satisfies these rules.

Method of Filing Forms



• The timelines track the Form W-2 rules.

• For example, the form is generally filed with the IRS by Feb.

28 (March 31 for electronic filing), and furnished to full-time

employees or responsible individuals by January 31.

• The information on the form pertains to the prior calendar year

and the first forms are due in 2016 (reporting information for

2015).

Due Date for Filing Forms



• Failure to timely and correctly report this information

(including employee’s SSN) may result in reporting penalties

under Code sections 6721 and 6722 for the large employer,

employer who is not a large employer, insurer or other entity

providing minimum essential coverage, which together

generally results in $200 per return risk (maximum of $3

million) per year.

Penalties of Noncompliance

Rules for Enrolling in

Marketplace



• Marketplaces are required by health care reform to have an

initial open enrollment period, an annual open enrollment

period, and certain special enrollment periods.

Initial, Annual, and Special Enrollment Periods Required for Marketplaces



• Annual Enrollment Period for Marketplaces

The annual open enrollment period for 2015 is set to begin November

15, 2014 and extend through February 15, 2015. Coverage will be

effective January 1, 2015 only for applications received by December

15, 2014.

Starting in 2014, the Marketplace must provide advance written notice

to each enrollee about annual open enrollment no earlier than

September 1, and no later than September 30.




• Special Enrollment Marketplaces for Marketplaces

• Health care reform requires Marketplace to offer special enrollment periods.

• Under final Marketplace regulations, the Marketplaces must allow qualified individuals and enrollees to enroll in a QHP or change from one to another as a result of the following triggering events: A qualified individual or dependent loses minimum essential coverage;

A qualified individual gains a dependent or becomes a dependent through marriage, birth, adoption, or placement for adoption;

An individual, who was not previously a citizen, national, or lawfully present individual gains such status;

A qualified individual’s enrollment or non-enrollment in a QHP is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, or inaction of the Marketplace or HHS;




• An enrollee adequately demonstrates to the Marketplace that the QHP in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee;

• An individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a QHP. (The Marketplace must permit individuals whose existing coverage through an eligible employer-sponsored plan will no longer be affordable or provide minimum value for his or her employer’s upcoming plan year to access this special enrollment period prior to the end of his or her coverage through such eligible employer-sponsored plan);

• A qualified individual or enrollee gains access to new QHPs as a result of a permanent move;

• An Indian may enroll in a QHP or change from one to another one time per month; and

• A qualified individual or enrollee demonstrates to the Marketplace that the individual meets other exceptional circumstances (as defined by the Marketplace).




• The special enrollment period generally is 60 days from the

date of the triggering event.

• Coverage must be effective as of the first day of the following

month for elections made by the 15th of the preceding month

and on the first day of the second following month for

elections made between the 16th and the last day of a month

(but coverage must be effective on the date of birth, adoption,

or placement for adoption, when that is the special enrollment

triggering event).




• Outside Open Enrollment

Outside Open Enrollment, an individual’s choices and savings will depend

on whether his or her COBRA coverage is running out or he or she is ending it early.

If the individual’s COBRA coverage is ending outside Open Enrollment, he or she will qualify for a special enrollment period.

This means the individual can enroll in a private health plan through the Marketplace.

An individual may qualify for tax credits that can lower his or her monthly premiums and for lower out-of-pocket costs.

If an individual is ending your COBRA coverage early outside Open Enrollment, he or she will not be able to enroll in a Marketplace plan at all, with or without lower costs.

Participation in COBRA



• During Open Enrollment

During the Open Enrollment period an individual can drop your COBRA

coverage and get a plan through the Marketplace instead.

This is true even if the individual’s COBRA coverage hasn’t run out.

When COBRA coverage ends and an individual applies for a

Marketplace plan during Open Enrollment, he or she may qualify for tax

credits that can lower his or her monthly premiums and for lower out-of-

pocket costs.




• A former employee who may enroll in COBRA or continuation

coverage under state law is considered eligible for minimum

essential coverage only for months that the individual is

enrolled in the coverage.

• A former employees on COBRA are only disqualified from

eligibility for premium tax credits for months in which they

actually enroll in employer-sponsored coverage.

• Family members of former employees would be accorded the

same treatment.


Contraceptive Coverage after

Hobby Lobby



• For plans subject to the Employee Retirement Income Security Act (ERISA), ERISA requires disclosure of information relevant to coverage of preventive services, including contraceptive coverage.

• Specifically, the Department of Labor’s longstanding regulations provide that, the summary plan description (SPD) shall include a description of the extent to which preventive services (which includes contraceptive services) are covered under the plan.

• if an ERISA plan excludes all or a subset of contraceptive services from coverage under its group health plan, the plan’s SPD must describe the extent of the limitation or exclusion of coverage.

Disclosure Requirements



• For plans that reduce or eliminate coverage of contraceptive

services after having provided such coverage, expedited

disclosure requirements for material reductions in covered

services or benefits apply.

• It require disclosure not later than 60 days after the date of

adoption of a modification or change to the plan that is a

material reduction in covered services or benefits.

• Other disclosure requirements may apply, for example, under

State insurance law applicable to health insurance issuers.”

Disclosure Requirements

Other Developments



• Two federal appeals courts ruled on a key provision of the ACA – and reached opposite conclusions.

• At issue is the component of the ACA that allows individuals who earn between 100% – 400% of the federal poverty level (FPL), or $11,670 and $46,680 for an individual, to be eligible to receive a subsidy to purchase insurance in a Health Insurance Marketplace (www.HealthCare.gov).

• Specifically at issue is the actual language of the ACA provision that says individuals living in states that have a Marketplace “established by the State” are eligible to receive subsidies if they meet the income eligibility criteria specified in the ACA.

A Tale of Two Decisions: Circuit Courts Divided on ACA Tax Credits



• The D.C. Circuit ruled 2-1 that the Internal Revenue Service

(IRS) lacks the authority to allow subsidies to be provided in

federally-facilitated Marketplaces.

• Conversely, the Fourth Circuit – based in Richmond, VA –

ruled that the law’s language is ambiguous, and that the IRS

is free to allow the subsidies in all states, including those with

federally-facilitated Marketplaces.

• Because there is uncertainty about the provision’s application,

the question may end up in the Supreme Court.




• The Obama administration has indicated that it will appeal the D.C. Circuit’s ruling.

• The Justice Department will ask the entire D.C. Circuit appeals court panel to review the decision (called an en banc hearing).

• That panel is dominated by judges appointed by Democrats, 7-4.

• The court’s rules indicate that the ruling will not become effective for 45 days to give the government time to ask for an en banc hearing, or 7 days after the en banc hearing has been denied.




• The U.S. Supreme Court has accepted review of a case

challenging the provision of premium tax credits on federal

Exchanges.

• It is expected that this case will be argued before the

Supreme Court in the spring, with a decision near the end of

the Court’s current term in June 2015.

• If the Court finds the regulation invalid, both the individual

mandate and Code § 4980H employer shared responsibility

penalties would be affected.




• DOL released updated model COBRA notices in May

• Both General Notice (sometimes called the COBRA Rights

Notice) and Election Notice models

• Located at: – http://www.dol.gov/ebsa/cobra.html

COBRA Notices Updated



• Revised COBRA General Notice:

Emphasizes ACA Marketplace, Medicaid, and possible spouse group

health coverage (and possible lower cost)

Simplifies multiple qualifying events

Contains a fair amount of wordsmithing (around 150 changes in total—

many minor)




• Revised COBRA Election Notice:

Emphasizes ACA Marketplace, Medicaid, and possible spouse group

health coverage (and possible lower cost) • “Cost” referenced 14 times!

Notes end of preexisting condition exclusions

Simplifies multiple qualifying events

Warns of subsequent restrictions on switching to other coverage




• Revised COBRA Election Notice:

Detailed Marketplace discussion • Enrollment rules and deadlines

• Marketplace contact information

• Switching coverage

• Special enrollment windows

Factors to consider: • Premiums

• Networks

• Drug formularies




• Section 213 of "Protecting Access to Medicare Act of 2014" repeals the annual deductible limit requirement for small employer insured health plans that was to be effective for plan years beginning on or after Jan. 1, 2014.

• The repeal of the Affordable Care Act's (ACA) deductible limit is retroactively effective to the date of the ACA's enactment in March 2010.

• President Obama signed the Protecting Access to Medicare Act of 2014 into law on April 1, 2014.

• Section 1302(c)(2)(A) of the ACA provided that deductible limits for 2014 could not exceed $2,000 for a plan covering a single individual, or $4,000 for any other plan.

• The proposed deductible limits for 2015 would be $2,150 for self-only coverage and $4,300 for other than self-only coverage.

New Law Repeals Deduction Limits for Small Employer Insured Health Plans



• The overall cost-sharing limits for plan years beginning in 2014 for non-grandfathered plans are the same as the maximum out-of-pocket expense limits for self-only and family coverage for HSA-compatible high-deductible health plans (HDHPs) for taxable years beginning in 2014.

• For 2014, these limits are $6,350 for self-only coverage and $12,700 for family coverage.

• The limits for 2015 are $6,600 for self-only coverage and $13,200 for other than self-only coverage.

• For HSA-compatible HDHP for 2015, the limits are $6,450 for self-only coverage and $12,900 for family coverage.

Cost -Sharing Limits update for 2015



• CMS indicated that an on-line process will be available at www.pay.gov to offer a “one-stop” resource for registration, submission of headcount and payment to CMS by December 5.

• Either the self-insured plan sponsor or the plan’s TPA can complete the reinsurance contribution process, including payment, on behalf of the self-funded plan.

• Whichever entity does so will be required to complete these steps: Register on pay.gov, so payment can be made when the time comes.

Enter the plan’s enrollment data in a on-line form called the “ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form.”

Prior to the submission of the form:

Attach “supporting documentation.”

Attest to the accuracy of the information.

Schedule payment for early 2015.

Reinsurance Fees



• The “vast majority” of taxpayers will just need to check a box on their tax returns indicating that they had health coverage in 2014.

• Taxpayers will use the information on Form 1095-A to compute the premium tax credit on their tax return and to reconcile the advance credit payments made on their behalf with the amount of the actual premium tax credit, which will be reported on Form 8962 .

• Taxpayers who did not have minimum essential coverage for 2014 and who are claiming an exemption from the individual mandate must report their coverage exemption on the now finalized Form 8965, and attach it to Form 1040.

Individual Mandate



• The IRS released Notice 2014-69 which provides that health plans that fail to provide substantial coverage for in-patient hospitalization services or for physician services (or for both) referred to as Non-Hospital/Non-Physician Services Plan) do not provide the minimum value intended by the minimum value requirements for the employer mandate.

• For an employers who has entered into a binding written commitment to adopt, or have begun enrolling employees in, a Non-Hospital/Non-Physician Services Plan prior to November 4, 2014 based on the employer's reliance on the results of use of the MV Calculator (a Pre-November 4, 2014 Non-Hospital/Non-Physician Services Plan), they will not be penalized for not meeting the employer mandate for the 2015 plan year if that plan year begins not later than March 1 2015.

Defining Minimum Value



• On October 31, 2014, CMS announced a delay, until further

notice, in enforcement of 45 CFR 162, Subpart E, the

regulations pertaining to health plan enumeration and use of

the Health Plan Identifier (HPID) in HIPAA transactions

adopted in the HPID final rule.

• This enforcement delay applies to all HIPAA covered entities,

including healthcare providers, health plans, and healthcare

clearinghouses.

Enforcement Delay of HPID



• CMS has announced that online enrollment will be available for 2015 coverage through the Small Business Health Options Program (SHOP—the Exchange for small businesses) beginning November 15, 2014.

• Online enrollment was delayed in 2013 , and employers were directed to work with an agent, broker, or insurer to complete and submit paper applications for 2014 .

• The bulletin explains that, for 2015, employers will be able to choose coverage, complete an application, and enroll entirely online.

• Employers can also work with a registered agent or broker, who will have enhanced online capabilities.

• CMS Bulletin: Get Health Care for Your Small Business (Oct. 8, 2014)

• Available at: http://content.govdelivery.com/accounts/USCMSHIM/bulletins/d3f753

Online Enrollment in SHOP Exchange Available for 2015

Questions?



• Larry Grudzien, Attorney at Law

Phone: 708-717-9638

Email: [email protected]

Website: www.larrygrudzien.com

Contact Information

new developments in health care reform

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